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Plummer-Vinson syndrome (PVS) or the Patterson-Brown-Kelly syndrome is a triad of iron deficiency anaemia (IDA), dysphagia and oesophageal webs. Commonly seen in middle-aged Caucasian females in the 4th to 7th decade, it is rare in males. It is usually a diagnosis made solely on clinical suspicion as history and clinical examination findings are equivocal. We have described a 55-year-old lady who presented with complaints of dysphagia and IDA. With all her initial investigations pointing towards gastritis, pure suspicion lead us to the diagnosis with a barium swallow. She was managed successfully with medications and currently on regular follow up. [ABSTRACT FROM AUTHOR]

This article discusses the potential of using a gene called ZmNAC78 to increase the iron content in maize kernels, which could help combat iron-deficiency anemia (IDA). IDA is a global public health problem that particularly affects children, pregnant women, and people in developing countries. The researchers found that overexpression of ZmNAC78 significantly increased the iron concentrations in maize kernels. They also developed a molecular marker to select maize varieties with iron-enriched kernels. This research provides new insights into the biological pathway of iron entry in maize grains and offers a promising and sustainable approach to reducing IDA in developing countries. [Extracted from the article]

The article focuses on the role of Advanced Practice Nurses (IPA) in addressing iron deficiency and anemia, emphasizing their expertise in providing comprehensive patient-centered care, prescribing treatments, coordinating care, and contributing to nursing research. Topics include the expanded scope of IPAs in managing iron deficiencies, legislative changes, and the integration of nursing sciences, encompassing holistic patient care, education, and counseling.

Introduction: Vulnerability to malnutrition is very high with low-income women and their children in rural Balochistan with contributing factors including lack of awareness about proper nutrition, low literacy, scarcity of vegetables and fruit, and low purchasing power of households. The Food and Agriculture Organization's kitchen garden program provides resources to improve nutrition and health knowledge and promote healthy eating practices. The objective of this study was to assess nutrition and health awareness, knowledge, attitudes, behavioural intentions/behaviours (AKAB) of women who attended the kitchen garden program and trainings. Materials and methods: A community based cross-sectional survey (N = 209) using a two-stage cluster sampling method was used to select households with survey participants being mothers with children under five years of age. A pretested questionnaire was administered via face-to-face surveys by trained enumerators in two districts of Balochistan province of Pakistan. Nutrition and health AKAB were constructed indices. Chi-square tests compared statistical differences in AKAB by women attending against a control group who did not-attend kitchen garden interventions. Binary logistic regression analyses were performed to assess kitchen garden program outcomes against key AKAB indicators, while adjusting for covariates. Results: Significant differences (p<0.001) were identified between intervention and control groups with women attending kitchen garden being more aware of the components of kitchen garden (65.8% vs 36.8%), and more knowledgeable about causes of illnesses caused by poor nutrition including, iron deficiency anemia, pregnancy, and unborn child health complications, compared to women not attending kitchen gardens program. Logistic regression analysis identified women attending kitchen gardens also had higher odds of being more knowledgeable (OR = 1.59, 95%CI 1.27–1.99, p<0.001), having improved attitudes (OR = 4.86, 95%CI 2.77–8.53, p <0.001), and behavioural intentions/behaviours (OR = 1.98, 95%CI 1.26–3.12, p = 0.003) towards improved nutrition and health. Conclusions: Substantial opportunities exist for achieving improved nutrition and health outcomes with vulnerable groups in Balochistan, through greater participation in kitchen gardens behavioural change programs and interventions. As part of scaling-up efforts, academically rigorous project evaluations should be institutionalized for continuous improvement of nutrition programs to address micronutrient deficiencies in rural communities. [ABSTRACT FROM AUTHOR]

Introduction The Women in Combat Summit 2021 "Forging the Future: How Women Enhance the Fighting Force" took place during February 9-11, 2021, via a virtual conference platform. The third and final day of the Summit regarded the physical health and well-being of military women and included the topics of urogenital health, nutrition and iron-deficiency anemia, unintended pregnancy and contraception, and traumatic brain injury. Materials and methods After presentations on the topics earlier, interested conference attendees were invited to participate in focus groups to discuss and review policy recommendations for physical health and well-being in military women. Discussions centered around the topics discussed during the presentations, and suggestions for future Women in Combat Summits were noted. Specifics of the methods of the Summit are presented elsewhere in this supplement. Results We formulated research and policy recommendations for urogenital health, nutrition and iron-deficiency anemia, contraception and unintended pregnancy, and traumatic brain injury. Conclusions In order to continue to develop the future health of military women, health care providers, researchers, and policymakers should consider the recommendations made in this supplement as they continue to build on the state of the science and forge the future. [ABSTRACT FROM AUTHOR]

T1-hyperintensity of the basal ganglia (BG) due to manganese deposition is a known radiologic finding in patients with hereditary hemorrhagic telangiectasia (HHT), but risk factors and associated clinical manifestations are unclear. This study conducted a quantitative analysis of the association of T1-hyperintensity in HHT patients with specific risk factors, signs, and symptoms. Patients seen at our center between 2005 and 2020 with a definitive diagnosis of HHT who had an available non-contrast T1-weighted brain MRI were included. Hyperintensity was evaluated using oval regions of interest measurements. The BG: thalamus intensity ratio was used to quantitatively evaluate T1-hyperintensity. Patient laboratory values and clinical findings were collected from electronic medical records. Hyperintensity was analyzed for its association with laboratory values, and clinical findings. Variables were analyzed through regression analysis. A total of 239 patients were included in this study. On 1.5 T scanners, values that were significant on multivariable regression analysis were age (p <.001), hepatic AVMs (p <.001), iron deficiency anemia (p =.0021), and cirrhosis (p =.016). On 3 T scanners, values that were significant on multivariable analysis were hepatic AVMs (p =.0024) and cirrhosis (p =.0056). On 3 T scanners, hyperintensity was significantly associated with tremor (OR = 1.17, p =.033), restless leg syndrome (OR = 1.22, p =.0086), and memory problems (OR = 1.17, p =.046). BG hyperintensity due to manganese deposition is significantly associated with hepatic risk factors on 1.5 T and 3 T scanners and iron deficiency anemia on 1.5 T scanners. On 3 T scanners, T1-hyperintensity is associated with neuropsychiatric signs and symptoms, such as tremor, restless leg syndrome, and memory problems. • T1-hyperintensity in the basal ganglia due to manganese deposition is a known finding in patients with hereditary hemorrhagic telangiectasia • However, the risk factors and clinical significance of these findings are unclear • Significant risk factors for deposition include increased age, iron deficiency anemia, hepatic AVMs, and liver cirrhosis • At a 3T field strength, significant associations were found between T1-hyperintensity and tremors, restless leg syndrome, and memory problems [ABSTRACT FROM AUTHOR]

Background and Aim: There is a paucity of evidence regarding non‐anemic iron deficiency as a predictor for colorectal cancer and therefore the indication for endoscopic evaluation. This study explores the rates of malignancy in adults with iron deficiency with and without anemia. Methods: A retrospective multicenter diagnostic cohort study was conducted across two Australian health services. All cases that underwent both esophagogastroduodenoscopy and colonoscopy between September 1, 2018, and December 31, 2019, for the investigation of iron deficiency were included, and the cohort was divided into anemic and non‐anemic arms. Multivariate binomial logistic regression was performed to establish clinical characteristics associated with neoplasia. Results: Five hundred eighty‐four patients underwent endoscopic evaluation over a 16‐month period. There was a significantly higher rate of malignancy in the iron deficiency anemia arm as compared with those without anemia (8.76% vs 1.20%, P < 0.01). Gastrointestinal pathology to account for iron deficiency was identified in > 60% of the total cohort. The presence of anemia (odds ratio [OR] 6.87, P < 0.01) and male gender (OR 3.01, P = 0.01) were significant predictors of malignancy. Conclusion: This study demonstrates that anemic iron deficiency confers a significantly greater risk of gastrointestinal cancer compared with non‐anemic iron deficiency. Additionally, over 60% of patients had gastrointestinal pathology to account for iron deficiency overall, supporting the need to perform baseline endoscopy in patients with iron deficiency. [ABSTRACT FROM AUTHOR]

Objective: To evaluate etiological spectrum of pancytopenia in adults using bone marrow aspiration biopsy. Study Design: Randomized Prospective study. Setting: Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. Period: October 2018-October 2020. Material & Methods: Eight hundred bone marrow biopsies were performed out of which 250 patients came with pancytopenia. 135 patients out of these were in adult age group which are included in this study. Results: Out of 250 patients adults were 135 that presented with pancytopenia. Male to female ratio came out to be 1.22:1. The most common disorder that results in pancytopenia came out to be megaloblastic anemia that was 29.6%, after that 26.6% were infection related changes, 10.3% aplasia, 9.6% reactive marrow, 5.9% acute leukemia, 3.7% chronic leukemia and iron deficiency anemia followed by 2.9% myelodysplastic syndromes and hypersplenism, 2.2% multiple myeloma, 1.4% mixed deficiency anemia and 0.74% myelofibrosis. We also analyzed patients on their presenting complaints as well. Most common complaint of presentation was fever (54.8%), (31.85%) with fatigue and malaise, (31.1%) pallor, vomiting and diarrhea (25.9%) followed by bleeding (14.8%). On clinical examination 12% cases presented with hepatomegaly and 16.6% with splenomegaly. Conclusion: Pancytopenia is a common hematological finding in our setup with megaloblastic anemia to be the most common cause of it. Therefore, it's very important to diagnose it as this is a curable (reversible) deficiency and patients can easily be managed to prevent serious hematological and neurological abnormalities. [ABSTRACT FROM AUTHOR]

Aim: Although loss of appetite in iron deficiency anemia (IDA) and weight gain during treatment are common complaints, there are very few studies in adults. This study aimed to determine the levels of ghrelin, one of the appetite-related hormones, and hepcidin, one of the main regulators of iron metabolism, in IDA, and to examine the effects of treatment on weight gain and the levels of these hormones. Material and Methods: Eighty-seven adult patients with IDA and a control group of 50 healthy volunteers were included in the study. Anthropometric measurements and blood samples were obtained from the patient and control groups before treatment, and repeated after treatment in the IDA group. Results: No significant difference was found in terms of weight, body mass index (BMI), and waist-to-hip ratio between groups but there was a significant increase in weight and BMI, in the patient group after treatment (both p<0.001). Pre-treatment hepcidin and ghrelin levels of the patient group were significantly lower than the control group (p<0.001, and p=0.026, respectively), and hepcidin levels increased significantly after treatment (p<0.001). The increase in ghrelin was not statistically significant but showed a positive weak correlation with both weight (r=0.254, p=0.018) and BMI (r=0.231, p=0.031) increase. Hepcidin levels were not correlated with weight and BMI changes. Conclusion: These findings revealed low levels of ghrelin and hepcidin in adults with IDA and an increase in weight and BMI with treatment. Hepcidin increased with treatment but was not correlated with weight gain, ghrelin was weakly correlated. [ABSTRACT FROM AUTHOR]

Iron deficiency anemia (IDA) is a leading global health concern affecting approximately 30% of the population. Treatment for IDA consists of replenishment of iron stores, either by oral or intravenous (IV) supplementation. There is a complex bidirectional interplay between the gut microbiota, the host’s iron status, and dietary iron availability. Dietary iron deficiency and supplementation can influence the gut microbiome; however, the effect of IV iron on the gut microbiome is unknown. We studied how commonly used IV iron preparations, ferric carboxymaltose (FCM) and ferric derisomaltose (FDI), affected the gut microbiome in female iron-deficient anemic mice. At the phylum level, vehicle-treated mice showed an expansion in Verrucomicrobia, mostly because of the increased abundance of Akkermansia muciniphila, along with contraction in Firmicutes, resulting in a lower Firmicutes/Bacteroidetes ratio (indicator of dysbiosis). Treatment with either FCM or FDI restored the microbiome such that Firmicutes and Bacteroidetes were the dominant phyla. Interestingly, the phyla Proteobacteria and several members of Bacteroidetes (e.g., Alistipes) were expanded in mice treated with FCM compared with those treated with FDI. In contrast, several Clostridia class members were expanded in mice treated with FDI compared with FCM (e.g., Dorea spp., Eubacterium). Our data demonstrate that IV iron increases gut microbiome diversity independently of the iron preparation used; however, differences exist between FCM and FDI treatments. In conclusion, replenishing iron stores with IV iron preparations in clinical conditions, such as inflammatory bowel disease or chronic kidney disease, could affect gut microbiome composition and consequently contribute to an altered disease outcome. [ABSTRACT FROM AUTHOR]

Gastric volvulus (GV) is a clinical condition that occurs due to abnormal rotation of the stomach around its mesentery by at least 180° and can present as either acute, recurrent, intermittent, or chronic foregut obstruction. While acute GV is a surgical emergency, given the imminent risk of ischemic necrosis and perforation, patients with chronic GV present with nonspecific abdominal and chest symptoms, which may go unnoticed until diagnosed during endoscopic or radiologic evaluation. In this case series, we describe five patients with chronic GV; two of whom underwent endoscopy for chronic iron deficiency anemia, while two others presented with recurrent hiccups and one presented with chronic burning epigastric and retrosternal discomfort. Fortunately, in one of our patients, endoscopic devolvulation was successful without further recurrence of GV, while the other four patients are being managed conservatively and have remained relatively stable and without any complications on follow-up. [ABSTRACT FROM AUTHOR]

Background Iron deficiency anemia (IDA) is one of the most common nutritional deficiencies worldwide. Constipation is one of the most common gastrointestinal disorders in childhood. Aim To screen for IDA or iron deficiency (ID) among children with chronic functional constipation (CFC). Patients and methods It was a prospective study. Two groups of children in the age range of 1–15 years were collected for 6 months from June 2022 to December 2022 at Alexandria University gastroenterology clinic. Children who fulfilled Rome IV criteria of CFC were assigned to CFC group. Children who did not have constipation were considered as the control group. Complete blood count, serum iron, total iron binding capacity, and serum ferritin were done for both groups. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. Quantitative data were described using range (minimum and maximum), mean, standard deviation, and median. Results Hemoglobin levels, serum ferritin and serum iron were significantly lower in the CFC group when matched with the control group. ID and IDA were significantly higher in the CFC group. The longer days of constipation were correlated with significantly lower hemoglobin, serum iron, and serum ferritin. Conclusion CFC causes mild IDA or ID. The longer the days of CF, the lower values of hemoglobin, iron and ferritin are present. ID and IDA are more common in the CFC group. [ABSTRACT FROM AUTHOR]

Background: The failure to identify a cause of iron deficiency in a substantial subset of patients with low iron stores raises the question of whether there are additional as of yet unexplained causes of iron depletion. Recently, there has been a growing body of evidence to suggest a relationship between Helicobacter pylori gastritis and iron deficiency anemia (IDA) in the absence of peptic ulcer disease. Aims and Objectives: Therefore, the present study was undertaken to investigate the effect of treatment of H. pylori with combination antibiotic therapy on IDA in patient with H. pylori-associated gastritis. Materials and Methods: The present study was carried out at a tertiary care hospital catering to a large population in south Solapur and nearby areas. The study was conducted for 2 years. All patients with IDA attending outpatient department and admitted to the hospital for 2 years, were included in the present study. All patients who have IDA according to the World Health Organization criteria, as a hemoglobin concentration <13 g/dL for men and <12 g/dL for women, a mean corpuscular volume (MCV) <75 fL and a serum ferritin level < 30 ng/mL, both in-patient and outpatient setting were evaluated with detail history, clinical examination, and investigation. Results: Baseline hemoglobin (Hb) in group I is 8.99±1.23, while in group II 7.55±2.08.All the parameters are comparable in groups I and II except baseline Hb%. There is a significant increase in Hb, packed cell volume (PCV), MCV, mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC) after 2 months of treatment with oral iron therapy. There is a significant increase in Hb, PCV, MCV, MCH, and MCHC after 2 months of treatment with oral iron and triple therapy for H. pylori. Conclusion: Treatment of H. pylori infection was associated with more rapid and significant response to oral iron therapy in IDA as compared with the use of iron therapy alone. [ABSTRACT FROM AUTHOR]

Objectives: Patient Blood Management (PBM) is defined as a patient‐centered, systematic, evidence‐based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. As a corollary, it also reduces the utilization of allogeneic blood components. However, demonstrating cost‐effectiveness depends on the health insurance system considered. This analysis aims to estimate the one‐year budget impact of PBM in four elective surgical areas, from French National Health Insurance and hospital perspectives. Methods: A budget impact model was developed to estimate the difference in the cost of care between scenarios with and without PBM. The impact of hematopoiesis optimization (first pillar of PBM) was studied throughout the management of preoperative anemia and iron deficiency in four types of surgeries: orthopedic, cardiac & cardiovascular, vascular & thoracic, and urologic & visceral surgery. Estimation of model's parameters was based on data collected in 10 French hospitals, literature, and on data from the French national medico‐administrative database. Results: A total of 980,125 patients were modeled for all four therapeutic areas. Results shows that implementation of a PBM program could generate annual savings up to €1079 M from the French National Health Insurance perspective (€1018 M from the hospital perspective), and the sparing of 181,451 red blood cells units per year. The deterministic sensitivity analysis showed that PBM generates savings for both perspectives in most parameters tested. Conclusion: Implementing PBM programs could result in important savings for the health care system in France. [ABSTRACT FROM AUTHOR]

Following a diagnosis of iron deficiency anaemia in pregnancy, iron supplements are prescribed using UK guidelines; however, despite this, the condition remains highly prevalent, affecting up to 30% of pregnant women in the UK. According to the World Health Organisation, it globally accounts for 45% in the most vulnerable groups of pregnant women and infants (<5 years old). Recently, the efficacy of iron replacement therapy and the effectiveness of current standard testing of iron parameters have been reviewed in order to evaluate whether a more accurate diagnosis can be made using alternative and/or supplementary markers. Furthermore, many questions remain about the mechanisms involved in iron metabolism during pregnancy. The most recent studies have shed more light on serum hepcidin and raised questions on the significance of pregnancy related inflammatory markers including cytokines in iron deficiency anaemia. However, research into this is still scarce, and this review aims to contribute to further understanding and elucidating these areas. [ABSTRACT FROM AUTHOR]

Background: Anemia is a global public health problem that particularly affects pregnant women and children. It results in significant adverse health outcomes for pregnant mothers and their offspring. Objectives: To determine the prevalence of anemia, its types, and the associated risk factors, among pregnant women attending Primary Healthcare Centers in the Kingdom of Bahrain. Methods: This is a cross-sectional study of pregnant women on their first visit (booking) to antenatal clinics at primary care centers, from the period of 1 January to 29 February 2020. A tested questionnaire was used to collect women data. Results of investigations including hemoglobin level and other tests were retrieved from electronic records. Results: The prevalence of anemia among pregnant women, attending their first antenatal visit in Primary Healthcare Centers is 28.8%. Of those cases, 59.3% were categorized as mildly severe, while 40.7% were moderately severe. The types of anemia identified were Iron Deficiency Anemia (IDA), vitamin B12 deficiencies and hemoglobinopathies in 39%, 30.8%, and 16% of cases, respectively. Conclusion: The prevalence of anemia among pregnant women attending their first antenatal visit in primary healthcare centers in the Kingdom of Bahrain is at 28.8% which is lower than the average worldwide rate reported by the WHO for anemia in pregnancy. IDA is the most prevalent type of anemia in the pregnant women. In this study, vitamin B12 deficiency significantly contributes to the prevalence of anemia among pregnant women. Further studies are required in order to explore the effects of pregnant women's dietary habits on anemia. Early booking is highly recommended in antenatal care to ensure early management of anemia. [ABSTRACT FROM AUTHOR]

Introduction: Effects of daily iron supplementation in iron replete pregnancy are unclear. This systematic review aimed to assess benefits and harms of oral iron supplements in pregnant women without anemia and iron deficiency. Material and methods: We predefined and registered a protocol in PROSPERO (CRD42020186210) and performed the review following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology. We searched for randomized clinical trials (RCTs) and observational studies comparing daily oral iron supplementation with no iron supplements in non‐anemic iron replete pregnant women. Searches were conducted in MEDLINE (by PubMed), EMBASE (by OVID), Cochrane Library, and ClinicalTrials.gov from inception to September 2022 without language restrictions. Two authors independently screened records, extracted data, and assessed risk of bias using the revised Cochrane risk of bias tool (RoB2). One author read full‐texts, assessed certainty of evidence by GRADE and conducted meta‐analyses using a random‐effects model. Primary outcomes included iron deficiency anemia, iron deficiency, hemoglobin >130 g/L, elevated iron status, small for gestational age newborns, low birthweight newborns, preterm birth, and congenital anomalies. Results: Eight RCTs (2822 women) but no observational studies were eligible for inclusion. Daily oral iron supplementation in pregnancy probably reduces iron deficiency anemia at term (risk ratio [RR]: 0.51, 95% confidence interval [CI]: 0.38–0.70; 4 RCTs, 1670 women; I2 = 13%; moderate‐certainty evidence) and the incidence of low birthweight babies (RR: 0.30, 95% CI: 0.13–0.68; 2 RCTs, 361 infants; I2 = 0%; moderate‐certainty evidence). In addition, it may reduce iron deficiency at term (RR: 0.74, 95% CI: 0.60–0.92; 4 RCTs, 1663 women; I2 = 58%; low‐certainty evidence) and the incidence of small for gestational age babies (RR: 0.39, 95% CI: 0.17–0.86; 1 RCT, 213 infants; I2 not estimable; low‐certainty evidence). Conclusions: Daily iron supplementation in iron replete non‐anemic pregnant women probably reduces the risk of maternal iron deficiency anemia at term and low birthweight. [ABSTRACT FROM AUTHOR]

Brain iron status is fundamental in RLS pathogenesis. The aim of this study was to determine the clinical efficacy and brain iron concentration improvement in RLS patients with IDA, using 1500 mg FCM. This is a randomized, double-blinded, placebo-controlled study. RLS patients with IDA were grouped into either 1500 mg FCM or placebo. The primary outcomes were the change from baseline on the International Restless Legs Syndrome Study Group scale (IRLS) and brain iron measured by QSM and R2∗. A total of 18 RLS patients with IDA were enrolled, 10 in the FCM group and 8 in the placebo. At the week 6 endpoint, the FCM group showed significant improvement in both IRLS (−13.60 ± 9.47 vs. −3.63 ± 5.40, p = 0.011) and VAS (−40.50 ± 28.81 vs. −0.63 ± 28.28, p = 0.004) from baseline. Change from baseline with R2∗ techniques showed a treatment effect for the thalamus and QSM technique for both the substantia nigra and pulvinar. A correlation was proved between the IRLS difference and the difference of QSM in thalamus (p = 0.028). This study demonstrates that 1500 mg FCM effectively treats RLS symptoms in IDA patients over six weeks, with MRI measurements of improved brain iron content serving as a potential biomarker for RLS patients. • Randomized, placebo-controlled study of ferric carboxymaltose (FCM) in RLS patients with iron deficiency anemia. • FCM group showed significant improvement in RLS symptoms. • Clinical improvement correlated with the improvement of brain iron level. [ABSTRACT FROM AUTHOR]

Ferric carboxymaltose (FCM)-induced hypophosphatemia is seen in up to 75% of patients receiving this therapy for iron deficiency anemia. Hypophosphatemia has been attributed to increased circulating levels of fibroblast growth factor-23 (FGF23), the transcription of which is upregulated in an iron-deficient state. However, hypophosphatemia typically resolves within 12 weeks of FCM administration. Here, we present a case of unusually prolonged hypophosphatemia that developed after treatment with FCM in a 39-year-old female with autosomal dominant polycystic kidney disease (ADPKD) but normal renal function. Workup was significant for low tubular reabsorption of phosphate and inappropriately normal FGF23. Genetic disorders of hypophosphatemia and a FGF23-secreting tumor were ruled out. Treatment with calcitriol was required for nearly 3.5 years. The prolonged hypophosphatemia was attributed to underlying ADPKD because these patients demonstrate inappropriately elevated FGF23 levels for the degree of severity of reduced glomerular filtration rate. However, the stimulus driving FGF23 secretion in these patients is incompletely understood. Elevated FGF23 in the kidney suppresses renal tubular phosphate reabsorption and 1α-hydroxylase activity ultimately leading to hypophosphatemia. We conclude that our patient was at a high risk of developing hypophosphatemia because of underlying ADPKD, and FCM was the likely precipitant to identify this underlying process. [ABSTRACT FROM AUTHOR]

We describe initial manifestations, approach to diagnosis, and treatment of a patient with congenital disorder of glycosylation type 1b (CDG 1b), previously managed as acetylcarnitine deficiency. A 9-year-old girl initially diagnosed with and treated for acetylcarnitine deficiency at an outside hospital presented with recurrent hypoglycemia, failure to thrive, poor weight gain, and short stature. She had discontinued levocarnitine therapy because of lack of response, and testing with us demonstrated a normal carnitine and acyl carnitine panel and hyperinsulinemic hypoglycemia during a diagnostic fast. Oral diazoxide and hydrochlorothiazide were initiated with resolution of hypoglycemia. She had iron deficiency anemia, but an upper gastrointestinal evaluation was normal. Genetic testing confirmed a diagnosis of CDG 1b caused by deficiency of mannose phosphate isomerase. Oral mannose was started with gradual reduction in and eventual discontinuation of the diazoxide dose. Hypoglycemia in the pediatric age group needs a systematic approach. It is important to raise awareness of CDG 1b, which can present as persistent hyperinsulinemic hypoglycemia. Mannose supplementation can ameliorate clinical symptoms and biochemical abnormalities. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency can impair immune function, increasing tuberculosis (TB) susceptibility and severity. The research aimed to investigate iron deficiency anemia in TB patients and household contacts and its association with natural resistance‐associated macrophage protein 1 (NRAMP1) polymorphism and expression. Methods: The levels of iron, ferritin, and transferrin were measured in the serum by ELISA (Enzyme‐Linked Immunosorbent Assay). NRAMP1 polymorphisms were determined by polymerase chain reaction (PCR) and sequencing. NRAMP1 gene expression was measured by real‐time PCR. Interferon‐gamma release assay (IGRA) checked on household contacts to screen household contacts with positive IGRA as the control. Results: This study involved 35 TB cases and 35 TB contacts. The results showed that the serum Fe levels were found to be lower in the TB case group (median 149.6 μmol/L) than in the positive IGRA household contacts group (median 628.53 μmol/L) with a p‐value <0.001. Meanwhile, ferritin levels in TB cases tended to be higher, in contrast to transferrin, which was found to tend to be lower in TB cases than household contacts but did not show a significant difference. This study found no association between the polymorphism of exon 15 D543 and active TB. However, NRAMP1 gene expression was lower in TB cases than in positive IGRA household contacts (p = 0.011). Besides, there was a positive correlation between NRAMP1 gene expression and serum Fe levels (r = 0.367, p = 0.006). TB was associated with decreased NRAMP1 gene expression (OR 0.086 95% CI 0.02–0.366, p = 0.001). Besides, TB was associated with low Fe levels (OR 0.533 95% CI 0.453–0.629, p < 0.001). Conclusion: Comparing the TB case to the household contacts group, decreased serum Fe levels were discovered in the TB case group. This study also shows a correlation of NRAMP1 gene expression to Fe levels in TB patients and household contacts and describes that TB may lead to decreased Fe levels by downregulating NRAMP1 expression. [ABSTRACT FROM AUTHOR]

Anemia is a common problem when patients present with cancer, and it can worsen during treatment. Anemia can directly impact the cognitive and physical quality of life and may impair fitness for oncological therapy. The most common cause of anemia is iron deficiency. Newer intravenous (IV) iron formulations offer a safe and rapidly effective treatment option. We performed a systematic mapping review of randomized controlled trials (RCTs) evaluating intravenous iron therapy in patients with cancer and anemia and their outcomes. A total of 23 RCTs were identified. The median number of patients enrolled was 104 (IQR: 60–134). A total of 5 were focused on surgical outcomes (4 preoperative, 1 postoperative), and 15 were in adjuvant therapies for a variety of tumor types (breast, colorectal, lung, gynecological, myeloid, and lymphomas), 10 of which were in combination with erythropoietin-stimulating agents (ESAs) therapy, 2 in radiotherapy, and 1 in palliative care. Overall, the studies reported that the use of IV iron increased hemoglobin concentration and decreased transfusion rates during different cancer treatment regimes. IV iron can be administered safely throughout the cancer treatment pathway from primary surgery to the palliative setting. More studies are needed to demonstrate net clinical outcomes. [ABSTRACT FROM AUTHOR]

Rapid increases in human populations and environmental changes of past decades have led to changes in rates of contact and spatial overlap with wildlife. Together with other historical, social and environmental processes, this has significantly contributed to pathogen transmission in both directions, especially between humans and non-human primates, whose close phylogenetic relationship facilitates cross-infections. Using high-throughput amplicon sequencing, we studied strongylid communities in sympatric western lowland gorillas, central chimpanzees and humans co-occurring in an unprotected area in the northern periphery of the Dja Faunal Reserve, Cameroon. At the genus level, we classified 65 strongylid ITS-2 amplicon sequencing variants (ASVs) in humans and great apes. Great apes exhibited higher strongylid diversity than humans. Necator and Oesophagostomum were the most prevalent genera, and we commonly observed mixed infections of more than one strongylid species. Human strongylid communities were dominated by the human hookworm N. americanus, while great apes were mainly infected with N. gorillae, O. stephanostomum and trichostrongylids. We were also able to detect rare strongylid taxa (such as Ancylostoma and Ternidens). We detected eight ASVs shared between humans and great apes (four N. americanus variants, two N. gorillae variants, one O. stephanostomum type I and one Trichostrongylus sp. type II variant). Our results show that knowledge of strongylid communities in primates, including humans, is still limited. Sharing the same habitat, especially outside protected areas (where access to the forest is not restricted), can enable mutual parasite exchange and can even override host phylogeny or conserved patterns. Such studies are critical for assessing the threats posed to all hosts by increasing human-wildlife spatial overlap. In this study, the term "contact" refers to physical contact, while "spatial overlap" refers to environmental contact. Author summary: Strongylid nematodes are common intestinal parasites, infecting a wide range of mammalian taxa, including humans and non-human primates (NHPs). They have evolved to live in vertebrate hosts for months or years and form complex communities within these hosts. Heavy strongylid infections can cause severe intestinal inflammation, intestinal lesions, respiratory difficulties, iron deficiency anemia, weight loss, childhood stunting, and adverse birth outcomes. As human population and human settlements have grown rapidly in recent decades, people often live in close proximity to wildlife, allowing for cross-transmission of soil-transmitted helminths. Because humans and NHPs (especially great apes) are closely related to one another evolutionarily, it is easy for strongylids infecting one primate species to jump to a different primate hosts. This evolutionary relationship can result in overlap and reciprocal exchange of pathogens and can have a damaging effect both on humans and NHP endangered species populations. As DNA-based diagnosis has become a routine part of modern parasitology, we employed a modern high-throughput sequencing approach to describe complex communities and zoonotic patterns of parasitic strongylid nematodes infecting humans and great apes in Cameroon. [ABSTRACT FROM AUTHOR]

Objective: To examine the incidence of adverse perinatal outcomes and the risk of adverse perinatal outcomes for Indian-born mothers compared to other mothers living and giving birth in Australia. Design, setting and participants: This retrospective cohort study was designed to investigate all births in Australia in 2012 and those in the Monash Health Birthing Outcomes System (BOS) 2014 to Indian-born mothers in Australia. Data sets were analysed involving descriptive statistics using Statistical Package for Social Sciences (SPSS vs. 23). Results: Indian-born mothers in Australia are at increased risk of induced labour, emergency caesarean section, very preterm birth (20–27 weeks), babies with low to very low birth weight, and low Apgar score (0–2) at 5 min, gestational diabetes, hypothyroidism, iron deficiency anaemia and vitamin B12 deficiencies compared to other mothers giving birth in Australia. This is despite a range of protective factors (25–34 years, married, nonsmokers, and a BMI < 30) that would normally be expected to reduce the risk of adverse perinatal outcomes for mothers giving birth in a developed country. Conclusion: In the absence of many of the recognized maternal risk factors, Indian-born mothers continue to face increased risk of adverse perinatal outcomes, despite access to high quality maternity care in Australia. Recommendations arising from this study include the need for an intervention study to identify maternal risk factors for Indian-born mothers in mid to late pregnancy that contribute to the risk for very preterm birth and low birth weight. [ABSTRACT FROM AUTHOR]

A new approach for fortification of drinking water is presented for combating iron deficiency anemia (IDA) worldwide. The idea is to leach Fe from a bed containing granular metallic iron (Fe0), primarily using ascorbic acid (AA). AA forms very stable and bioavailable complexes with ferrous iron (FeII). Calculated amounts of the FeII-AA solution can be added daily to the drinking water of households or day-care centers for children and adults (e.g. hospitals, kindergartens/schools, refugee camps) to cover the Fe needs of the populations. Granular Fe0 (e.g., sponge iron) in filters is regarded as a locally available Fe carrier in low-income settings, and, AA is also considered to be affordable in low-income countries. The primary idea of this concept is to stabilize FeII from the Fe0 filter by using an appropriate AA solution. An experiment showed that up to 12 mg Fe can be daily leached from 1.0 g of a commercial sponge iron using a 2 mM AA solution. Fe fortification of safe drinking water is a practicable, affordable and efficient method for reducing IDA in low-income communities. [ABSTRACT FROM AUTHOR]

Background Prompt detection of colorectal cancer (CRC) among individuals younger than age 50 years (early-onset CRC) is a clinical priority because of its alarming rise. Methods We conducted a matched case-control study of 5075 incident early-onset CRC among US commercial insurance beneficiaries (113 million adults aged 18-64 years) with 2 or more years of continuous enrollment (2006-2015) to identify red-flag signs and symptoms between 3 months to 2 years before the index date among 17 prespecified signs and symptoms. We assessed diagnostic intervals according to the presence of these signs and symptoms before and within 3 months of diagnosis. Results Between 3 months and 2 years before the index date, 4 red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with odds ratios (ORs) ranging from 1.34 to 5.13. Having 1, 2, or at least 3 of these signs and symptoms were associated with a 1.94-fold (95% confidence interval [CI] = 1.76 to 2.14), 3.59-fold (95% CI = 2.89 to 4.44), and 6.52-fold (95% CI = 3.78 to 11.23) risk (P trend < .001), respectively, with stronger associations for younger ages (P interaction < .001) and rectal cancer (P heterogenity = .012). The number of different signs and symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. Approximately 19.3% of patients had their first sign or symptom occur between 3 months and 2 years before diagnosis (median diagnostic interval = 8.7 months), and approximately 49.3% had the first sign or symptom within 3 months of diagnosis (median diagnostic interval = 0.53 month). Conclusions Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC. [ABSTRACT FROM AUTHOR]

Introduction: Bone marrow examination (BME) is a reliable and effective tool in the diagnosis of many haematological and non‐haematological diseases and may be used to investigate unexplained cytopenia in human immunodeficiency virus (HIV) infected patients. The objective of this study was to determine the diagnoses made, diagnostic yield and unique diagnostic yield of BMEs performed to investigate cytopenias in HIV infected patients. Method: A retrospective cross‐sectional descriptive study was performed involving all BMEs performed on HIV‐infected adult patients with the main indication of unexplained cytopenia over a period of 5 years and 4 months. Data was extracted from the National Health Laboratory Service's laboratory information system and clinicians' BME request forms. Results: The study included 128 BMEs, performed on 124 patients. The diagnostic yield was 32% and the unique diagnostic yield was 30.5%. The most common diagnosis was pure red cell aplasia (10.9%), followed by immune thrombocytopenic purpura (ITP) (7%), iron deficiency anaemia (6.3%), malignancy (4.7%) and disseminated infection (3.9%). Conclusion: BME is a useful investigation for unexplained cytopenia in HIV‐infected patients. Less invasive investigations to exclude haematinic deficiencies, haemolysis and sepsis are recommended on an individualised basis prior to BME. In HIV‐infected patients with therapy refractory ITP or ITP with atypical clinicopathological findings, BME is strongly recommended. As Mycobacterial and other infections are common in this group of patients, staining and culture of specimens are advised if BME is undertaken. [ABSTRACT FROM AUTHOR]

Further studies are needed to confirm the association of HS disease severity with severity of anaemia and to explore long term impacts of untreated anaemia in this patient population. Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the follicular pilosebaceous unit that produces painful nodules, abscesses, fistulas, malodorous drainage and scarring within skin folds.[1] HS represents the intersection between disease of the integumentary system and systemic disease as HS patients have a higher overall comorbidity burden than healthy and psoriasis patients.[2] Although anaemia is a well-recognized comorbidity in chronic inflammatory conditions, there's a paucity of research exploring anaemia's role in HS, and available studies have reported conflicting results.[[3], [5], [7], [9]] Moreover, the type of anaemia associated with HS needs to be explored as it is unclear whether patients have anaemia of chronic disease, iron-deficiency anaemia, coexistence of both or other types. HS patients aged >=70 years had a 3.27-fold increase in odds of anaemia compared to HS patients aged 18-29 years (95% CI, 3.25-3.28). [Extracted from the article]

Background: Blood donors at the extremes of the age spectrum (16–19 years vs. ≥75 years) are characterized by increased risks of iron deficiency and anemia, and are often underrepresented in studies evaluating the effects of donor characteristics on red blood cells (RBC) transfusion effectiveness. The aim of this study was to conduct quality assessments of RBC concentrates from these unique age groups. Study design: We characterized 150 leukocyte‐reduced (LR)‐RBCs units from 75 teenage donors, who were matched by sex, and ethnicity with 75 older donors. LR‐RBC units were manufactured at three large blood collection centers in the USA and Canada. Quality assessments included storage hemolysis, osmotic hemolysis, oxidative hemolysis, osmotic gradient ektacytometry, hematological indices, and RBC bioactivity. Results: RBC concentrates from teenage donors had smaller (9%) mean corpuscular volume and higher (5%) RBC concentration compared with older donors counterparts. Stored RBCs from teenage donors exhibited increased susceptibility to oxidative hemolysis (>2‐fold) compared with RBCs from older donors. This was observed at all testing centers independent of sex, storage duration, or the type of additive solution. RBCs from teenage male donors had increased cytoplasmatic viscosity and lower hydration compared with older donor RBCs. Evaluations of RBC supernatant bioactivity suggested that donor age was not associated with altered expression of inflammatory markers (CD31, CD54, and IL‐6) on endothelial cells. Conclusions: The reported findings are likely intrinsic to RBCs and reflect age‐specific changes in RBC antioxidant capacity and physical characteristics that may impact RBC survival during cold storage and after transfusion. [ABSTRACT FROM AUTHOR]

Background and Objectives: It is important to get the right amount of nutrition during adolescence because there are significant growth changes during this time. Undernutrition and iron deficiency anemia are the two main nutritional issues affecting the adolescent population, among other things. To find out how common anemia is in adolescent girls in the Kakatiya Medical College Warangal, AP urban field practice area. to identify various socio-demographic elements that affect adolescent girls' anemia. Methods: A cross-sectional study was conducted in three areas that were part of the Warangal, Kakatiya Medical College's urban health center, which serves as a field practice area. Between November 2021 and October 2022, the study was carried out. 350 teenage girls (aged 10 to 19) in total were enrolled in the study. To gather information about the socio-demographic variables, a pre-designed and pre-tested proforma was used. Each participant underwent a pertinent clinical examination. With the help of cyanomethemoglobin, hemoglobin was estimated. When the hemoglobin level fell below 12 gm/dl, anaemia was determined to be the cause. Results: Anaemia was prevalent in 81.1% of the population, with mild anemia accounting for 36.9%, moderate anemia for 40.9%, and severe anemia for 3.4%. When compared to late adolescents (15-19 years old), it was found that early adolescents (10-14 years old) had a higher prevalence of anemia. Most of the girls were moderately anemic. Girls living in hostels with working mothers and illiterate fathers were significantly more likely to have anemia than non-hostel residents. Conclusion: It was discovered that adolescent girls had a high prevalence of anemia, which was particularly high in the early adolescents. Anemia and father's educational background and employment status were significantly correlated. Giddiness and anemia were strongly correlated. [ABSTRACT FROM AUTHOR]

Introduction: Anaemia is the most common nutritional deficiency in the world. The group with the greatest number of individuals affected being pregnant women (41.8%). Menstrual blood loss, pregnancy and delivery are the main causes of anaemia in reproductive-age women. Anaemia is an important cause of maternal mortality. Complaints like lethargy, easy fatigability, dizziness, lactation failure, post-partum depression are not unusual findings in patients with postpartum anaemia (PPA). It is estimated that 20-40% of maternal deaths in India are due to anaemia. Aims: To find out and compare the efficacy, safety, and tolerability of intravenous ferric carboxymaltose and oral ferrous sulfate in improving haemoglobin concentration in iron deficiency anaemia during post partum period. Materials and Methods: The present study was a Hospital based study in which prospective, comperative observation study. This Study was conducted from 18 months at Department of Dept. of Obstetrics and Gynaecology, Chittaranjan Seva Sadan College of Obs. Gnae. And Child Health, 37, S.P Mukherjee Road, Kolkata -700026. Result: showed that the mean level of Ferritin of the patients in Intravenous Group was significantly higher than that of the patients in Oral Group (p<0.0001). Conclusion: In this present study Ferric carboxymaltose produced significantly greater and sustained increases in Hb and Ferric carboxymaltose was superior to oral iron in improving iron stores, as measured by ferritin. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency anemia is India's most prevalent type of anemia. Glycated hemoglobin (HbA1c) is utilized as a marker to represent 3-month glucose levels. Like blood sugar levels, variable hemoglobin, hemolytic anemia, nutritional anemias, uremia, pregnancy, and acute blood loss affect HbA1c values. However, there is inconsistent information regarding how iron deficiency anemia affects HbA1c levels. Aim: This study was conducted to study the effects of iron deficiency anemia on HbA1c levels and determine if treating iron deficiency anemia impacts HbA1c levels. Material & Methods: By the inclusion and exclusion criteria, fifty-six non-diabetic adult patients with age > 18 years and Iron Deficiency Anemia admitted to various medical wards and visiting OPDs of R.D Gardi Medical College and CRG Hospital, Ujjain, were enrolled as the study group(Group A- Microcytic hypochromic) along with 56 healthy controls(Normocytic normochromic). A comprehensive clinical history was gathered, and biochemical testing, including HbA1c, was performed. With the help of appropriate statistical software, SSPS 26 did all statistical analysis. Results: Compared to non-Anemic non-diabetic patients, iron-deficient anemic nondiabetic patients have higher mean HbA1c values. The mean HbA1c levels for the control group were 5.44 ± 0.3. The mean HbA1c levels for the case group was 5.80 ± 0.42. The difference is statistically significant, with a p-value of < 0.001. Conclusion: Therefore, we conclude that iron deficiency anemia independently influences HbA1c levels in non-diabetic people, and it must be assessed cautiously in all iron-deficient anemic patients. [ABSTRACT FROM AUTHOR]

The role of iron in neurodevelopment has long been recognized, and the adverse effects of early‐life iron deficiency on brain development and subsequent function across the lifespan continue to be a subject of research. A greater appreciation of the contribution of maternal preconceptional iron status and fetal iron accretion to offspring, postnatal iron status, and brain health across the lifespan has occurred over the past decade. This paradigm shift in thinking links two previously relatively siloed literatures: neonatal iron deficiency and postnatal iron deficiency. The understanding that iron accretion during the fetal period strongly influences postnatal iron balance has led to an appreciation of the importance and value of ensuring proper fetal iron loading. This article reviews the dynamics of fetal iron metabolism, the role of iron in the developing fetal brain, the short‐ and long‐term neurobehavioral consequences of fetal iron underloading, and the potential mechanisms that account for the long‐term effects of fetal/neonatal iron deficiency. Synopsis: Adequate fetal iron loading is critical to prevent fetal and postnatal iron deficiency and to protect brain development and function across the lifespan. [ABSTRACT FROM AUTHOR]

The symptom of heavy menstrual bleeding and the frequently associated condition of iron deficiency (ID) individually and collectively adversely impact the lives of women and girls of reproductive age in various ways. The insidious but sometimes profound effects of periconceptual ID on the developing fetus may continue throughout the individual's life with consequences that are also felt by families, friends, and society at large. Unfortunately, in most instances, current healthcare policies are not designed to address the plethora of issues in a fashion that will result in meaningful improvement in health and other outcomes that affect both individuals and society. Identification and prioritization of the many evidence gaps will be an essential component of the strategy for change. This article identifies and describes the evidence gaps and provides direction for investigators and those involved in healthcare policy. Synopsis: While an improved understanding of iron deficiency and its adverse impacts on women and girls of reproductive age, pregnancy, and the fetus exists, many evidence gaps remain. [ABSTRACT FROM AUTHOR]

Over 50% of pregnant women are anemic and the majority of these are iron deficient. Micronutrient deficiency, the symptom of heavy menstrual bleeding in nonpregnant individuals, and loss of blood associated with pregnancy and obstetric delivery contribute to iron deficiency (ID). Poor outcomes with low maternal iron can affect not only the pregnancy but can also have major bearings on the offspring. Correction of ID and iron deficiency anemia (IDA) in pregnant and prepregnant populations with single‐dose intravenous iron supplementation may offer improved outcomes. A harmonization process that incorporates all major randomized controlled trials studying the use of single‐dose IV iron compared with oral iron may suggest actions for changing the global trajectory of ID/IDA for women and girls of reproductive age. Synopsis: Emerging science proposing single‐dose intravenous iron supplementation may change the global trajectory of iron deficiency and iron deficiency anemia in women and girls of reproductive age. [ABSTRACT FROM AUTHOR]

Iron deficiency (ID) is the most common micronutrient deficiency in the world. It is of concern for women and girls of reproductive age as, despite frequent normalization, excessive menstrual blood loss and the iron demands associated with pregnancy increase the risk of developing an ID. Iron deficiency reduces health‐related quality of life with symptoms of fatigue, heart palpitations, difficulty concentrating, and poor mental health. When left untreated, ID can escalate to iron deficiency anemia (IDA), where there is an insufficiency of red blood cells, or hemoglobin within these cells, to meet the bodily demands for oxygen transport. Substantial guidance on screening for ID can be found in specific at‐risk groups, including pregnant women and patients with renal, cardiac, and inflammatory bowel disease. However, it was unclear whether guidance is available for women of reproductive age. We performed a literature search to explore the current recommendations for screening women of reproductive age for ID. While four manuscripts supportive of screening were found, no official guidance appears to exist regarding screening for this group. In line with the World Health Organization's 10 Principles of Screening, we present a case for ID screening in women and girls of reproductive age. Synopsis: Following review of current practice and the World Health Organization's 10 Principles of Screening, there is an evident need for iron deficiency screening in women and girls of reproductive age. [ABSTRACT FROM AUTHOR]

Abnormal uterine bleeding (AUB) is common, often debilitating, and may affect over 50% of reproductive‐aged women and girls. Whereas AUB is a collection of symptoms that include intermenstrual bleeding and abnormalities in period duration, cycle length, and regularity, it is heavy menstrual bleeding (HMB) that is most contributory to iron deficiency and related anemia. It is apparent that AUB, in general, and HMB, in particular, remain underrecognized and underreported. FIGO created two systems for assessing and classifying AUB. FIGO System 1 defines the bleeding pattern using four primary descriptors: frequency, duration, regularity, and flow volume. FIGO System 2 provides a structured classification system of possible causes of AUB, using the acronym PALM‐COEIN. "PALM" refers to structural causes of AUB (Polyp, Adenomyosis, Leiomyoma, Malignancy), and "COEI" refers to nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, and Iatrogenic). The "N" is reserved for those entities that are currently not otherwise classified. Using FIGO System 1 as a gateway to FIGO System 2 streamlines the investigation of reproductive‐aged women and girls with AUB. Understanding the pathogenesis of the FIGO System 2 "PALM‐COEIN" causes helps interpret investigations and the onward management of AUB. Numerous evidence gaps exist concerning AUB; however, if researchers and trialists universally adopt FIGO Systems 1 and 2 for the assessment and diagnosis of AUB, clear translatable research findings can be applied globally. Synopsis: Abnormal uterine bleeding and its associated conditions (iron deficiency with/without anemia) are underrecognized and underreported, requiring precise, systematic assessment using FIGO systems 1 and 2. [ABSTRACT FROM AUTHOR]

Iron deficiency (ID) is the world's most common disorder and one of the top five causes of years lived with disability. Whereas low serum ferritin is diagnostic of ID, ferritin—an acute phase reactant—may be elevated in inflammatory states and the first trimester of pregnancy even if ID exists. Consequently, in early pregnancy or chronic inflammation, percent transferrin saturation (TSAT) measurement is the best indicator of iron status. Unfortunately, current guidelines do not recommend routine screening for ID in either pregnant or nonpregnant women in the absence of anemia. This circumstance should be urgently reviewed based on available data. While oral formulations have long been the standard for iron replacement therapy and are widely available and inexpensive, oral iron is frequently associated with adverse gastrointestinal effects for the majority—a major reason for poor adherence, inadequate repletion, and persisting ID symptoms and sequellae. Although safe intravenous iron administration was introduced in the mid‐1950s, formulations with cores binding the elemental iron more tightly became available in the 2000s, allowing complete and safe replacement, even in a single setting. Prospectively acquired neonatology evidence reports oral iron's failure to reach the developing fetus when the mother is iron deficient. Consequently, while oral iron remains frontline in the first trimester because of insufficient safety data for intravenous iron, the author recommends that the intravenous route should be the gold standard for second‐trimester ID when hemoglobin concentrations are less than 10.5 g/dL and for all iron‐deficient women in their third trimester. Synopsis: The treatment of iron deficiency and iron deficiency anemia in reproductive‐aged women and girls requires revisiting and represents an unmet clinical need. [ABSTRACT FROM AUTHOR]

For girls and women in their reproductive years, the symptom of heavy menstrual bleeding (HMB) is the most common cause of iron deficiency (ID), including the extreme manifestation of iron deficiency anemia (IDA). It is recognized that these two clinical entities are not only ubiquitous, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both HMB and ID/IDA adversely impact quality of life—HMB during the episodes of bleeding and ID daily as long as the ID exists. These combined issues undermine the lives of reproductive‐aged girls and women of all ages, from menarche to menopause. At the same time, pervading culture and the often insidious nature of these disorders frequently lead to societal normalization, including by healthcare professionals. The effects on cognitive function as well as the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence suggesting that ID, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders—effects that can have widespread impacts on society. Collectively, this critically important evidence begs the implementation of diagnostic and management guidelines aimed at identifying iron‐deficient girls and women, repleting their iron stores, and, when present, effectively treating the most common reason for the problem—the various causes of the symptom of HMB. Synopsis: Heavy menstrual bleeding commonly causes iron deficiency that not only adversely affects quality of life, but, when present periconceptually, can result in impaired fetal neurodevelopment. [ABSTRACT FROM AUTHOR]

Context Iron deficiency and anemia have serious consequences, especially for children and pregnant women. Iron salts are commonly provided as oral supplements to prevent and treat iron deficiency, despite poor bioavailability and frequently reported adverse side effects. Ferrous bisglycinate is a novel amino acid iron chelate that is thought to be more bioavailable and associated with fewer gastrointestinal (GI) adverse events as compared with iron salts. Objective A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effects of ferrous bisglycinate supplementation compared with other iron supplements on hemoglobin and ferritin concentrations and GI adverse events. Data sources A systematic search of electronic databases and grey literature was performed up to July 17, 2020, yielding 17 RCTs that reported hemoglobin or ferritin concentrations following at least 4 weeks' supplementation of ferrous bisglycinate compared with other iron supplements in any dose or frequency. Data extraction Random-effects meta-analyses were conducted among trials of pregnant women (n = 9) and children (n = 4); pooled estimates were expressed as standardized mean differences (SMDs). Incidence rate ratios (IRRs) were estimated for GI adverse events, using Poisson generalized linear mixed-effects models. The remaining trials in other populations (n   =   4; men and nonpregnant women) were qualitatively evaluated. Data analysis Compared with other iron supplements, supplementation with ferrous bisglycinate for 4–20 weeks resulted in higher hemoglobin concentrations in pregnant women (SMD, 0.54 g/dL; 95% confidence interval [CI], 0.15–0.94; P < 0.01) and fewer reported GI adverse events (IRR, 0.36; 95%CI, 0.17–0.76; P < 0.01). We observed a non-significant trend for higher ferritin concentrations in pregnant women supplemented with ferrous bisglycinate. No significant differences in hemoglobin or ferritin concentrations were detected among children. Conclusion Ferrous bisglycinate shows some benefit over other iron supplements in increasing hemoglobin concentration and reducing GI adverse events among pregnant women. More trials are needed to assess the efficacy of ferrous bisglycinate against other iron supplements in other populations. PROSPERO registration no CRD42020196984. [ABSTRACT FROM AUTHOR]

Background: Inflammation has several effects in the geriatrics with reference to iron deficiency anemia (IDA), anemia of chronic disease (ACD), and unexplained anemia (UA). Whether hyperinflammation is part of their pathogenesis or just incidental is unknown. Data are limited regarding inflammatory patterns in IDA, ACD, and UA in anemic geriatrics and inflammation as a component of UA. There is little known about the overlap of inflammation between ACD and UA. Objective: The study was undertaken to find the proportion of anemic geriatric patients, aged ≥60 years with raised serum levels of inflammatory markers and their study within IDA, ACD, and UA. Materials and Methods: Seventy-five anemic geriatric patients were evaluated for raised serum levels of inflammatory markers: high sensitive C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) along with serum ferritin (SF). Results: Raised markers were seen in 94.7% of anemic geriatric patients.IL-8 was raised most frequently followed by TNF-α, IL-6, hsCRP, and SF. No distinct inflammatory profile could be elicited between ACD and UA. The hyperinflammatory profile irrespective of the underlying etiology of geriatric anemia suggests that aging per se is pro-inflammatory state. Conclusion: Geriatric anemia can be thought to develop on background of subclinical low-grade inflammation along with superimposed nutritional deficiencies or chronic diseases. [ABSTRACT FROM AUTHOR]

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of iron deficiency anemia on HbA2 levels. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital, Lahore Pakistan, from Jan to Oct 2020. Methodology: A total of 206 subjects were included in the study out of which 56 served as healthy controls. Five milliliters of whole blood were extracted in an EDTA tube and basic haematological parameters were performed using automated hematology analyzer (Sysmex KX-21). HbA2 levels were determined by cellulose acetate hemoglobin electrophoresis at alkaline pH (Mini Hor-8). Serum Ferritin levels were measured by chemiluminescence on Cobas e411 and Serum Iron levels by spectrophotometric method using ferrozine (Cobas c501). Results: Mean hemoglobin in control group was 12.5±0.7 g/dL and in iron deficiency anemia group was 8.1±1.36 g/dL (p=0.01). Mean HbA2 level in control group was 2.69±0.24% and iron deficiency anemia group was 1.76±0.25 % (p=0.001). HbA2 levels were reduced in individuals having haemoglobin levels less than 10g/dL and remained unchanged/minimally changed with hemoglobin levels reaching near normal levels. Conclusion: There was a statistically significant association of HbA2 levels with degree of anemia and serum ferritin levels (p=0.001). [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of platelet indices as a tool for differentiation between clonal thrombocytosis and reactive thrombocytosis. Study Design: Cross sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital, Lahore Pakistan, from Nov 2019 to Oct 2020. Methodology: Fifty-six subjects were included in Reactive thrombocytosis group and 56 in Clonal thrombocytosis group. Fresh blood in EDTA anticoagulant was analyzed to determine complete blood counts and platelet parameters (Platelet distribution width, mean platelet volume, Platelet large cell ratio, Plateletcrit) using the automated hematological analyzer Sysmex KX-21. Results: Mean age of the patients was 45.76 years with a range of 17-75 years. Assessing the cause of reactive thrombocytosis revealed that 20(35.7%) was infection and 16(28.5%) was iron deficiency anemia. In clonal thrombocytosis group 21(37.5%) were diagnosed with Chronic myeloid leukemia, 13(23.2%) with Essential thrombocythemia and 14(25%) with Polycythemia rubera vera. Platelet indices were compared in clonal thrombocytosis group and the reactive thrombocytosis group. Mean platelet volume, Platelet large cell ratio and Plateletcrit were significantly higher in the clonal thrombocytosis group (p=0.001). Difference in Platelet distribution width was not found to be statistically significant in the two groups (p=0.07) Conclusion: Platelet indices were higher in the clonal thrombocytosis group. Along with platelet count, they can serve as an efficient and cost-effective method in differentiating between clonal and reactive thrombocytosis. [ABSTRACT FROM AUTHOR]

Anemia and iron deficiency (ID) are common complications in patients with pancreatic ductal adenocarcinoma (PDAC), but their underlying causes remain unclear. This study investigated the incidence and characteristics of anemia and micronutrient deficiencies in PDAC patients before initiating chemotherapy. A total of 103 PDAC patients were included, comprising 67 in the palliative and 36 in the adjuvant groups. The overall incidence of anemia was 42.7% (n = 44), with comparable rates in both groups. Normocytic and normochromic anemia were predominant, with mild and moderate cases observed in 32% and 10.7% of the cohort, respectively. ID was evident in 51.4% of patients, with absolute ID more frequent in the adjuvant than in the palliative group (19.4% vs. 13.4%). Functional ID occurred more often in the palliative than in the adjuvant group (41.8% vs. 25%). Vitamin B12 and folate deficiency occurred in <5% (n = 5) of patients. Furthermore, 8.7% (n = 9) of patients had chronic kidney disease and anemia. To elucidate mechanisms of iron deficiency, the study explored the expression of iron regulators (hepcidin (HEP), ferroportin (FPN), and ZIP14 protein) and mitochondrial mass in PDAC tissue with immunohistochemical (IHC) staining and Perl's Prussian blue to detect iron deposits on available tumor samples (n = 56). ZIP14 expression was significantly higher in less advanced tumors (p = 0.01) and correlated with mitochondrial mass (p < 0.001), potentially indicating its role in local iron homeostasis. However, no significant impact of tissue iron regulators on patient survival was observed. Perl's Prussian blue staining revealed iron deposits within macrophages, but not in pancreatic duct cells. Furthermore, the GEPIA database was used to compare mRNA expression of iron regulators (HEP, FPN, and ZIP14) and other genes encoding iron transport and storage, including Transferrin Receptor Protein 1 (TfR1) and both ferritin chain subunits (FTH and FTL), in PDAC and normal pancreatic samples. FPN, TfR1, FTH, and FTL showed higher expression in tumor tissues, indicating increased iron usage by cancer. ZIP14 expression was higher in the pancreas than in PDAC and was correlated with FPN expression. The study highlights the importance of baseline iron status assessment in managing PDAC patients due to the high incidence of anemia and iron deficiency. Furthermore, ZIP14, in addition to HEP and FPN, may play a crucial role in local iron homeostasis in PDAC patients, providing valuable insights into the underlying mechanisms of iron dysregulation. [ABSTRACT FROM AUTHOR]

Background: Anaemia is a reduction in haemoglobin concentration below a threshold, resulting from various factors including severe blood loss during and after childbirth. Symptoms of anaemia include fatigue and weakness, among others, affecting health and quality of life. Anaemic pregnant women have an increased risk of premature delivery, a low-birthweight infant, and postpartum depression. They are also more likely to have anaemia in the postpartum period which can lead to an ongoing condition and affect subsequent pregnancies. In 2019 nearly 37% of pregnant women globally had anaemia, and estimates suggest that 50–80% of postpartum women in low- and middle-income countries have anaemia, but currently there is no standard measurement or classification for postpartum anaemia. Methods: A rapid landscape review was conducted to identify and characterize postpartum anaemia measurement searching references within three published systematic reviews of anaemia, including studies published between 2012 and 2021. We then conducted a new search for relevant literature from February 2021 to April 2022 in EMBASE and MEDLINE using a similar search strategy as used in the published reviews. Results: In total, we identified 53 relevant studies. The timing of haemoglobin measurement ranged from within the immediate postpartum period to over 6 weeks. The thresholds used to diagnose anaemia in postpartum women varied considerably, with < 120, < 110, < 100 and < 80 g/L the most frequently reported. Other laboratory results frequently reported included ferritin and transferrin receptor. Clinical outcomes reported in 32 out of 53 studies included postpartum depression, quality of life, and fatigue. Haemoglobin measurements were performed in a laboratory, although it is unclear from the studies if venous samples and automatic analysers were used in all cases. Conclusions: This review demonstrates the need for improving postpartum anaemia measurement given the variability observed in published measures. With the high prevalence of anaemia, the relatively simple treatment for non-severe cases of iron deficiency anaemia, and its importance to public health with multi-generational effects, it is crucial to develop common measures for women in the postpartum period and promote rapid uptake and reporting. [ABSTRACT FROM AUTHOR]

H. pylori (ubiquitous) and anemia together represent one of the growing health concerns globally. Gastroduodenal sequelae of H. pylori infection are distinguished; however, for the H. pylori infection and its implication in the development of anemia, iron has a significant health impact. We aimed to evaluate H. pylori infection-associated anemia by employing a logistic regression analysis model. A retrospective (case–control) study design-based assessment of the H. pylori associated-anemia. The study area was geo-referenced by QGIS/QuickMapServies. Descriptive and inferential statistical analyses were accomplished using the R-base–R-studio (v-4.0.2)-tidyverse. A p-value < 0.05 was the statistical significance cut-off value. A ggplot2 package was used for data representation and visualization. Mean ± SD age, Hb, MCV, ferritin, and RBC for overall study participants were measured to be 44.0 ± 13.58, 13.84 ± 2.49, 83.02 ± 8.31, 59.42 ± 68.37, and 5.14 ± 0.75, respectively. Decreased levels of Hb (infected vs. uninfected: 13.26 ± 2.92 vs. 14.42 ± 1.75, p < 0.001) ferritin (infected vs. uninfected: 48.11 ± 63.75 vs. 71.17 ± 71.14, p < 0.001), and MCV (infected vs. uninfected: 81.29 ± 9.13 vs. and 84.82 ± 6.93, p < 0.05) were measured to be associated with H. pylori infection when compared with H. pylori uninfected control group. Moreover, the magnitude (prevalence) of anemia (infected vs. uninfected: 78% vs. 21%, p < 0.001), iron deficiency anemia (IDA) (infected vs. uninfected: 63.3% vs. 36.6%, p < 0.001), and microcytic anemia (infected vs. uninfected: 71.6% vs. 46.1%, p < 0.001) were significantly different among the H. pylori-infected participants. The higher likelihood of developing anemia (AOR; 4.98, 95% CI; 3.089–8.308, p < 0.001), IDA (AOR; 3.061, 95% CI; 2.135–4.416, p < 0.001), and microcytic anemia (AOR; 3.289, 95% CI; 2.213–4.949, p < 0.001) by 398%, 206.1%, and 229%, respectively, was associated with H. pylori-infected. We recommend the regular monitoring of hematological parameters and eradication of H. pylori infection to minimize the extra-gastric health consequences of H. pylori infection. [ABSTRACT FROM AUTHOR]

Reticulocyte hemoglobin (CHr) is a measure of the amount of hemoglobin in reticulocytes and a marker of cell hemoglobinization. In this study, we aimed to find the optimal cut-off point for reticulocyte hemoglobin to diagnose iron deficiency anemia using multiple methods. A total of 309 patients were included. The median age at diagnosis was 54 years. Most were females (71.2%). 68% had iron deficiency anemia. Patients with IDA had significantly lower levels of CHr compared to those who had non-IDA (p < 0.0001). The optimal cut-off value of CHr for detecting IDA, determined using various methods, was 30.15 pg. This cut-off point had a sensitivity of 87.8% and a specificity of 77.7%. CHr showed a significant positive correlation with hemoglobin, mean corpuscular volume, serum iron, serum ferritin, and transferrin saturation and a significant negative correlation with total iron-binding capacity. CHr levels correlate with most established laboratory tests for IDA. It reliably detects IDA. Our results indicate the importance of CHr in diagnosing IDA, and that CHr should be used more widely in suspected cases of IDA since it is a cheap, fast, and reliable test. [ABSTRACT FROM AUTHOR]

Background: Abnormal uterine bleeding (AUB), which includes heavy menstrual bleeding (HMB), is a common condition placing women at increased risk for developing iron deficiency and iron deficiency anemia (IDA). Depletion of iron stores has negative implications on physical, social, and emotional health, as well as quality of life. Iron supplements are safe, effective, and readily available, while red blood cell (RBC) transfusions have inherent risks including infectious and immune reactions. Despite high prevalence of IDA among women with AUB, there are limited studies on the impact of iron therapies on patient outcomes. This systematic review and meta-analysis will evaluate the impact of iron supplementation on patient outcomes for women with AUB, when compared to combination therapy, no intervention, placebo, or standard of care. Methods: We will conduct a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the impact of iron interventions on patient outcomes for women with AUB. Systematic literature searches will be conducted in major databases including MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science. Studies assessing the impact of iron interventions on patient outcomes in women experiencing AUB, in comparison to combination therapy, no intervention, placebo, or standard of care, will be included in the review. Independent reviewers will screen for eligibility, assess risk of bias, and abstract data. Overall certainty of evidence for each outcome will be assessed using the GRADE approach. We will meta-analyze outcomes which are sufficiently homogeneous to summarize intervention effects and narratively synthesize nonhomogeneous outcomes. The main outcomes of interest are hemoglobin levels immediately prior to surgery and post-operatively, number of RBC transfusions, and adverse effects. Secondary outcomes will include length of hospital stay, intraoperative blood loss, adverse and side effects, quality of life, and iron indices. Discussion: This review will evaluate the impact of iron interventions on patient outcomes in women with IDA secondary to AUB with focus on changes in hematological and iron indices, red blood cell utilization, quality of life, cost of treatment, and adverse events. The results will inform evidence-based clinical practice for the management of iron deficiency and IDA secondary to AUB. Systematic review registration: PROSPERO CRD42019137282. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Food insecurity describes the lack of adequate and reliable access to food due to insufficient resources. The condition affects over one-quarter of the world’s population and is exacerbated by factors such as conflicts, climate variability, rising costs of nutritious food, and economic slumps; these challenges are amplified by poverty and inequality. Food insecurity is associated with many negative health outcomes, such as iron deficiency anemia, poor oral health, and stunting of growth in children. Case Report: We present the case of a patient who had significant weight loss related to food insecurity then developed a rare adverse health outcome: superior mesenteric artery (SMA) syndrome. SMA syndrome is a condition in which reduction in the angle formed by the proximal SMA and aorta, most commonly from decreased mesenteric fat in the setting of significant weight loss, leads to compression of the third portion of the duodenum and resulting bowel obstruction. The patient underwent successful treatment with a novel approach: endoscopic placement of a gastrojejunostomy stent. Conclusions: Food insecurity remains a wide-ranging public health issue that can have direct impact on the clinical outcomes of individuals. We describe SMA syndrome as a rare adverse outcome in a food insecure individual, adding to the growing list of health consequences associated with this condition. We also highlight endoscopic placement of a gastrojejunostomy stent as an emerging alternative to surgical treatment of SMA syndrome. The success of the procedure in this patient adds to the body of evidence supporting its efficacy and safety profile for this population. [ABSTRACT FROM AUTHOR]