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ABSTRACT: Background: The bone marrow iron study is the gold standard for differentiation of the two most common causes of anemia i.e. iron deficiency anemia (IDA) and anemia of chronic disease (ACD) in the elderly. However, it is often not feasible to do bone marrow examination (BME) in every elderly anemic patient, due to its invasive nature. Hepcidin, a liver-derived peptide, has been identified as the key systemic regulator of iron homeostasis. Our study highlights the potential diagnostic role of serum hepcidin in the evaluation of anemia in elderly. Methodology: Hundred elderly patients (≥60 years of age) having iron deficiency anemia (IDA) or anemia of chronic disease/inflammation (ACD) were the study subjects with 15 age-matched healthy controls. All patients were evaluated with history, clinical examination, routine investigations (complete blood count, liver, and kidney function tests), iron profile, and serum hepcidin. The bone marrow iron study was done in every patient to categorize them as IDA and ACD. Results and Discussion: Serum iron, TIBC, MCV, ferritin, and serum transferrin saturation values were differing significantly between IDA and ACD groups. Serum hepcidin levels can be used confidently to differentiate ACD from IDA (P value <0.001). At serum concentration, 198.82 ng/mL sensitivity of hepcidin to differentiate ACD from IDA was 93.9% and specificity was 92.2%. A subset of patients is misdiagnosed when the serum hepcidin level is used as a sole marker, and this also holds true for serum ferritin. Conclusion: Though serum hepcidin level correlates well with serum iron profile and also serum hepcidin appears to be a useful marker to differentiate ACD from IDA in terms of both sensitivity and specificity, the combined assessment of serum hepcidin and iron profile appears to be a better marker than ferritin and hepcidin alone. This could replace the use of bone marrow iron staining as a diagnostic tool in anemia in elderly. [ABSTRACT FROM AUTHOR]

Iron deficiency anemia (IDA) is a well-known cause of stroke in children, but its association is relatively rare in adults. We describe a case of 36-year-old woman, a known diabetes mellitus, who presented with recurrent vomiting, headache, and altered sensorium. Investigations revealed severe iron deficiency anemia, thrombocytosis, and ketoacidosis. Magnetic resonance imaging suggested acute infarct of B/L parieto-occipito-temporo-cerebellar region. Patient was worked up for possible causes of stroke in young. She underwent computed tomography angiography of the brain, echocardiogram, and screening for thrombophilia disorders. This, however, did not demonstrate a clear etiology and there were no other evidences of diabetic angiopathy. Some previously published case reports have suggested IDA as a potential cause of ischemic stroke; it is possible that the stroke in this young woman was attributable to severe IDA. Whether cerebrovascular accident has led to diabetic ketoacidosis or vice versa is a topic of discussion which needs further studies. Moreover, such catastrophes could be prevented by early diagnosis and timely management through involvement of primary care physicians.

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease leading to the destruction of articular cartilage and deformity of joints if not detected early. There is an unmet need to find out a highly sensitive and specific biomarker for RA. This was the first study designed in Indian setting to assess whether it can be used as a biomarker in the diagnosis of RA in the Indian population. Aim: To correlate serum Beclin1 in the pathogenesis of rheumatoid arthritis in the Indian population. Patients and Methods: Observational analytical study was conducted for 18 months at AIIMS Rishikesh, Department of Biochemistry in collaboration with the Department of Rheumatology. Beclin1 serum expression levels were estimated by the enzyme-linked immunosorbent assay and beclin1 mRNA expression was assessed by a real-time polymerase chain reaction from peripheral blood mononuclear cells (PBMCs). Beclin1 expression was compared by Mann–Whitney U-test using SPSS 22 version. Cut-off values of Beclin1 for screening of cases were analysed by receiver operating characteristic test. Results: Age- and sex-matched 38 RA patients (5 males and 33 females) and 39 controls (8 males and 31 females) were recruited in the study. Patients with the American College of Rheumatology/European League Against Rheumatism score ≥6 were recruited in this study. Serum level of beclin1 was significantly (P ≤ 0.001) lower in cases (6.30 [2.82]) compared to healthy controls (11.43 [4.62]) which were corroborated with mRNA expression. The optimal cut-off value for detecting RA cases was 7.25 with 89.7% sensitivity and 79.8% specificity. Conclusion: Beclin1 may be involved in the pathogenesis of RA and may be considered a diagnostic marker for RA cases. [ABSTRACT FROM AUTHOR]

Amitraz is a worldwide available pesticide of formamidine chemical family, proven to have reversible toxic effects on both animals and humans. Upon intoxication by ingestion, inhalation, or dermal route, it can cause various central nervous system (CNS), CVS, respiratory and gastrointestinal effects, some of which may be life threatening. Because of lack of specific antidote patients are usually managed with supportive and symptomatic management. We describe a case of 36-year-old female patient who presented to us with alleged history of 120 ml amitraz ingestion. She was given early gastric lavage with activated charcoal at emergency along with supportive and symptomatic management. She developed mild CNS depression, bradycardia, miosis, and fluctuating blood pressure. She was managed in intensive care unit and was kept under close hemodynamic monitoring. Her clinical course during hospital stay was uneventful and was successfully discharged without any residual deficits. According to previously published data, this amount of amitraz intoxication could have caused more serious clinical manifestations. This disproportionately less severe clinical manifestation in our patient is attributed to early gastric lavage. Ominous of reducing amitraz-related health hazards lies in the hands of primary health care physicians and regulatory bodies of government. [ABSTRACT FROM AUTHOR]

Sheehan syndrome (SS) is postpartum hypopituitarism resulting from pituitary gland necrosis caused by severe hypotension due to massive intra or post-partum hemorrhage. Defective NaCl transport in the distal convoluted tubule, due to mutations affecting the thiazide sensitive Na-Cl-cotransporter results in the autosomal recessive salt-losing renal tubulopathy, Gitelman syndrome (GS). These two have been rarely described together. We report the case of a middle-aged woman with both these conditions, resulting in management issues. Physicians encountering unexplained hypokalemia refractory to standard management must consider the possibility of renal tubular disorders. [ABSTRACT FROM AUTHOR]

Competing Interests: Declaration of interests We declare no competing interests.

Rheumatoid arthritis (RA) commonly presents as a chronic additive symmetric inflammatory polyarthritis involving the small and large joints. Rarely do patients present with few or no clinical symptoms, despite apparent signs of inflammation. This condition, known as arthritis robustus, typically occurs in elderly males who are manual laborers with an active lifestyle. It is essential to diagnose arthritis robustus and start treatment promptly to avoid the development of deformities and other complications in the future., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bhogaraju et al.)

Competing Interests: The authors declare no conflict of interest.