DOCSLIB.ORG

Ejim.Ejim 100 19.Pdf

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

874 Original article Investigation of association of biomarkers of iron metabolism and insulin resistance in Egyptian patients with impaired glucose metabolism and type 2 diabetes Ibrahim N. El Ebrashya, Olfat Shakerb, Sarah I. Abdelgalila, Elham M. Yousiefa Departments of aInternal Medicine, bMedical Introduction Biochemistry & Molecular Biology, Faculty of Type 2 diabetes is an expanding overall medical issue. A large portion of the Medicine, Cairo University, Cairo, Egypt enthusiasm for the job of supplements in diabetes is fixated on macronutrients, yet a Correspondence to Elham M. Yousief, MD, 66 micronutrient, iron, is additionally closely connected with diabetes. Gamaet Eldwal, Mohandseen, Giza, 12511, Aim Egypt. Tel: +20 122 221 7049; e-mail: [email protected] To study biomarkers of iron metabolism, including serum ferritin, transferrin saturation, iron, and insulin resistance, in diabetic and prediabetes patients. Received: 11 July 2019 Patients and methods Accepted: 1 October 2019 Published: 18 A ugust 2020 This is a cross-sectional study directed on a cohort of 50 patients, comprising 25 patients with impaired glucose tolerance and 25 patients recently discovered to The Egyptian Journal of Internal Medicine 2019, 31:874–883 have type 2 diabetes mellitus (T2DM), as well as 20 healthy controls of matched age and both sexes. All patients enrolled in the study were subjected to full history taking, full examination, laboratory investigations including iron, total iron-binding capacity, ferritin, insulin, lipid profile, fasting blood glucose, 2-h postprandial glucose, urea, creatinine, complete blood count, alanine aminotransferase, and aspartate aminotransferase. Results We found that patients with T2DM have significant higher body weight and BMI than prediabetes patients and controls, and also statistically significant difference in serum iron between the studied groups, but no statistical significance in serum ferritin between the studied groups. In addition, we found a positive correlation of serum iron and insulin resistance in T2DM, a significant positive correlation of serum ferritin with low-density lipoprotein and negative correlation with high-density lipoprotein in T2DM, positive correlation of ferritin with cholesterol and triglycerides in impaired glucose tolerance group. Moreover, transferrin saturation was negatively correlated with glycated hemoglobin, BMI, and total iron-binding capacity and is positively correlated with iron and creatinine and hemoglobin among the studied groups. Conclusion The distinguished relationship of several markers of iron metabolism with hyperglycemia and insulin resistance recommends that iron stores add to the pathogenesis of IGM and T2DM. Keywords: ferritin, impaired glucose tolerance, iron, type 2 diabetes mellitus, transferrin saturation Egypt J Intern Med 31:874–883 © 2020 The Egyptian Journal of Internal Medicine 1110-7782 Moreover, an overrepresentation of diabetes cases Introduction has likewise been identified among people with Type 2 diabetes is a typical and increasing overall states of obtained iron overburden, for example, medical issue. It is very much acknowledged that the thalassemia major [3]. This could clarify that most solid indicator for the disease is obesity; therefore, abnormal amounts of body iron are a hazard factor consideration has additionally been paid to the for type 2 diabetes in the community, and this may have commitment of supplements and supplement- suggestions for the prevention and treatment of type 2 detecting pathways in circumstances of endless diabetes. Cross-sectional and prospective studies report caloric abundance. A large portion of the enthusiasm a positive relationship between ferritin and type 2 for the job of supplements in diabetes is focused on diabetes [4,5]. Ferritin is additionally an acute phase macronutrients, yet a micronutrient, iron, is likewise intently connected with diabetes [1]. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Inherited hemochromatosis, a hereditary issue License, which allows others to remix, tweak, and build upon the work portrayed by fundamental iron overburden, is non-commercially, as long as appropriate credit is given and the new accounted for to be related with diabetes [2]. creations are licensed under the identical terms. © 2020 The Egyptian Journal of Internal Medicine | Published by Wolters Kluwer - Medknow DOI: 10.4103/ejim.ejim_100_19 Biomarkers of iron metabolism El Ebrashy et al. 875 reactant and is increased in the presence of committee. All procedures followed were in accordance inflammation, liver disease, and insulin resistance, with the ethical standards of the responsible committee on which are likewise connected with type 2 diabetes human experimentation (institutional and national) and [6,7]. Different biomarkers of iron metabolism may with the Helsinki Declaration of 1975, as revised in 2000. give additional data on the role of iron in the Informed consent was obtained from all patients for being pathogenesis of type 2 diabetes. Transferrin is the included in the study. All participants signed a written iron-binding protein available for use, and its levels informed consent form before enrollment in the study to increase with growing iron prerequisites. Serum iron is complete the requirement of the ethical committee of the hard to interpret in separation, as it has a diurnal variety faculty of physical therapy, Cairo University, andto ensure and consequently differs altogether without changes in complete satisfaction. All patients of the study were all out-body iron [8]. Transferrin saturation (TSAT) is informed about the study, its aim, and all risks and the extent of transferrin bound to serum iron and is to expected benefits, and they were also assured of their some extent a marker of iron absorption; it mirrors the anonymity and confidentiality of data obtained before extent of coursing iron in the milieu of iron signing the informed consent. prerequisites. TSAT is raised within the sight of nontransferrin-bound iron, which thus is in charge Quantitation of ferritin in serum of iron-related oxidative harm [9,10]. The serum level of ferritin was measured using an ELISA kit provided by Immunospec Corporation We research the independent relationship of the (Canoga Park, California, USA). markers of iron processing, serum ferritin, transferrin, TSAT, and iron with hyperglycemia and Principle of the test insulin resistance in Egyptian population with impaired glucose tolerance (IGT) and type 2 The Immunospec Ferritin Quantitative Test Kit diabetes mellitus (T2DM), attempting to affirm the depends on a solid-phase compound-connected role of ferritin in insulin resistance and T2DM. immunosorbent examination. The measured framework uses charge interaction of ferritin to the wells of microtiter plate for solid phase immobilization, Patients and methods and then a mouse monoclonal antibody for ferritin The present study included three groups of patients aged conjugated with a neutralizer catalyst (horseradish 30–45 years. Participants were recruited from Internal peroxidase) is added. Ferritin is allowed to interact Medicine Department and Clinic of Tertiary Care all the while with the antibodies, bringing about the Hospital and were divided into group A, which ferritin atoms being sandwiched between the strong included 25 patients newly diagnosed with T2DM; stage and protein-connected antibodies. Following a group B, which included 25 patients with IGT; and 30-min incubation at room temperature, the wells are group C, which included 20 healthy controls. The washed to expel unbound antibodies. Then TMB exclusion criteria were (a) type I DM, (b) pregnancy- (chromogenic substrate used in staining procedures induced DM, (c) drug-induced diabetes, (d) liver and in immunohistochemistry as well as being a kidney diseases, and (e) hereditary hemochromatosis. visualizing reagent used in enzyme-linked immunosorbent assays) is included and incubated for In all patients, thorough clinical evaluation was 15 min; it interacts with enzyme and brings about the performed including fasting blood sugar, 2-h advancement of a blue shading. The shading postprandial (2HPP) sugar, glycated hemoglobin improvement is ceased with the expansion of stop (HbA1C), serum triglycerides (TGs), total cholesterol, arrangement, and the shading is changed to yellow high-density lipoprotein (HDL) cholesterol, low- and estimated by ELISA peruse at 450 nm. The density lipoprotein (LDL) cholesterol, serum aspartate centralization of ferritin is straightforwardly aminotransferase, alanine aminotransferase, serum corresponding to the shading power of the test. urea, creatinine, serum insulin measured by radioimmunoassay used in homeostatic measurement Materials provided with the test kits include the assessment insulin resistance (HOMA-IR), serum following: iron, total iron-binding capacity (TIBC), TSAT, serum ferritin, and albumin-creatinine ratio in urine. (1) Antibody-covered microtiter plate with 96 wells. (2) Reference standard set, which contains 0, 15, 50, This cross-sectional study was conducted from April 2017 200, 400, and 800 ng/ml (fluid, prepared to utilize). till April 2018 after approval of the institutional ethical (3) Enzyme conjugate reagent, 12 ml. 876 The Egyptian Journal of Internal Medicine, Vol. 31 No. 4, October-December 2019 (4) TMB substrate, 12 ml. and patient examples was determined. A standard
Recommended publications
  • Evaluation of Iron Profile in Type II Diabetes Mellitus Cases

    Evaluation of Iron Profile in Type II Diabetes Mellitus Cases

    International Journal of Biotechnology and Biochemistry ISSN 0973-2691 Volume 15, Number 1 (2019) pp. 27-37 © Research India Publications http://www.ripublication.com Evaluation of Iron Profile in Type II Diabetes Mellitus Cases Dr. Sayantaann Saha*, Dr. Roopa Murgod Department of Biochemistry Vydehi Institute of Medical Sciences and Research Centre, EPIP Area, Whitefield, Bangalore 560066, India. ABSTRACT Introduction: Type 2 diabetes mellitus is the most common metabolic disorder, characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Iron, a transitional metal has been shown to play a major role in pathogenesis of T2DM with a bi-directional relationship where iron affects glucose metabolism, and glucose metabolism in turn impinges on several iron metabolic pathways. Aims or Objectives: To estimate and compare the parameters related to iron metabolism viz. Serum Iron (Fe), Serum Ferritin, Serum TIBC (Total Iron Binding Capacity), Serum Transferrin and Transferrin Saturation with Fasting Blood Sugar (FBS) between T2DM patients and healthy controls and correlation of FBS with the above iron parameters. Material and methods: A case control study was conducted between 41 cases of confirmed T2DM patients and 40 age & sex matched healthy controls. Iron profile parameters & FBS were estimated in both the groups and compared. Iron parameters were also correlated with FBS. * Corresponding author(Dr. Sayantaann Saha), Email id: [email protected] 28 Dr. Sayantaann Saha, Dr. Roopa Murgod Results: Serum ferritin, Serum iron & serum transferrin saturation were found to be significantly higher in patients with T2DM compared to control group (P<0.001). Serum transferrin & serum TIBC were found to be slightly lower in cases as compared to controls (P<0.001).
  • K392-100 Total Iron-Binding Capacity (TIBC) and Serum Iron Assay Kit (Colorimetric)

    K392-100 Total Iron-Binding Capacity (TIBC) and Serum Iron Assay Kit (Colorimetric)

    FOR RESEARCH USE ONLY! Total Iron-Binding Capacity (TIBC) and Serum Iron Assay Kit (Colorimetric) rev 08/19 (Catalog # K392-100; 100 assays; Store at -20°C) I. Introduction: BioVision’s TIBC and Serum Iron Assay Kit measures both Total iron-binding capacity (TIBC) and Serum iron. Those values indicate the requisite iron for transferrin saturation and Serum Iron respectively. In humans, Transferrin is a blood protein that binds and transports iron throughout the body. Iron bound to transferrin and not bound are reflected in the following: 1) Total Iron Binding Capacity, 2) Unbound Iron, 3) Transferrin Saturation Bound Iron, and 4) Free Iron. Those measurements can be used for to detect and monito transferrin saturation and also iron-deficiency anemia and chronic inflammatory diseases. Part A: TIBC Part B: Serum Iron 1 1 2 2 3 3 4 II. Application: Determination of TIBC, Unbound Iron, Transferrin Saturation, Serum Iron III. Sample Type: Serum or plasma. Serum-off-the clot is preferable to normal serum. IV. Kit Contents: Components K392-100 Cap Code Part Number TIBC Assay Buffer 25 ml WM K392-100-1 Iron Solution 100 µl Blue K392-100-2 TIBC Detector 2 x 1.5 ml Brown K392-100-3 TIBC Developer 5 ml NM K392-100-4 Iron Standard (100 mM) 100 µl Yellow K392-100-5 V. User Supplied Reagents and Equipment: • 96-well plate clear plate with flat bottom • Microplate reader capable of absorbance reading VI. Storage Conditions and Reagent Preparation: Store kit at -20°C, protected from light. Briefly centrifuge small vials prior to opening.
  • Gamma-Glutamyltransferase: a Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk

    Gamma-Glutamyltransferase: a Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk

    Hindawi Publishing Corporation Disease Markers Volume 2015, Article ID 818570, 18 pages http://dx.doi.org/10.1155/2015/818570 Review Article Gamma-Glutamyltransferase: A Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk Gerald Koenig1,2 and Stephanie Seneff3 1 Health-e-Iron, LLC, 2800 Waymaker Way, No. 12, Austin, TX 78746, USA 2Iron Disorders Institute, Greenville, SC 29615, USA 3Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA 02139, USA Correspondence should be addressed to Gerald Koenig; [email protected] Received 2 July 2015; Accepted 20 September 2015 Academic Editor: Ralf Lichtinghagen Copyright © 2015 G. Koenig and S. Seneff. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gamma-glutamyltransferase (GGT) is a well-established serum marker for alcohol-related liver disease. However, GGT’s predictive utility applies well beyond liver disease: elevated GGT is linked to increased risk to a multitude of diseases and conditions, including cardiovascular disease, diabetes, metabolic syndrome (MetS), and all-cause mortality. The literature from multiple population groups worldwide consistently shows strong predictive power for GGT, even across different gender and ethnic categories. Here, we examine the relationship of GGT to other serum markers such as serum ferritin (SF) levels, and we suggest a link to exposure to environmental and endogenous toxins, resulting in oxidative and nitrosative stress. We observe a general upward trend in population levels of GGT over time, particularly in the US and Korea. Since the late 1970s, both GGT and incident MetS and its related disorders have risen in virtual lockstep.
  • Iron Deficiency Anemia: Evaluation and Management MATTHEW W

    Iron Deficiency Anemia: Evaluation and Management MATTHEW W

    Iron Deficiency Anemia: Evaluation and Management MATTHEW W. SHORT, LTC, MC, USA, and JASON E. DOMAGALSKI, MAJ, MC, USA Madigan Healthcare System, Tacoma, Washington Iron deficiency is the most common nutritional disorder worldwide and accounts for approxi- mately one-half of anemia cases. The diagnosis of iron deficiency anemia is confirmed by the findings of low iron stores and a hemoglobin level two standard deviations below normal. Women should be screened during pregnancy, and children screened at one year of age. Supple- mental iron may be given initially, followed by further workup if the patient is not responsive to therapy. Men and postmenopausal women should not be screened, but should be evaluated with gastrointestinal endoscopy if diagnosed with iron deficiency anemia. The underlying cause should be treated, and oral iron therapy can be initiated to replenish iron stores. Paren- teral therapy may be used in patients who cannot tolerate or absorb oral preparations. (Am Fam Physician. 2013;87(2):98-104. Copyright © 2013 American Academy of Family Physicians.) ▲ Patient information: ron deficiency anemia is diminished red causes of microcytosis include chronic A handout on iron defi- blood cell production due to low iron inflammatory states, lead poisoning, thalas- ciency anemia, written by 1 the authors of this article, stores in the body. It is the most com- semia, and sideroblastic anemia. is available at http://www. mon nutritional disorder worldwide The following diagnostic approach is rec- aafp.org/afp/2013/0115/ I and accounts for approximately one-half of ommended in patients with anemia and is p98-s1.html. Access to anemia cases.1,2 Iron deficiency anemia can outlined in Figure 1.2,6-11 A serum ferritin level the handout is free and unrestricted.
  • Correlation Between Serum Bilirubin and Serum Ferritin Level in Thalassaemia Patients N Sultana1, S Sadiya2, MH Rahman1 1Dept

    Correlation Between Serum Bilirubin and Serum Ferritin Level in Thalassaemia Patients N Sultana1, S Sadiya2, MH Rahman1 1Dept

    ORIGINAL ARTICLE Correlation between serum bilirubin and serum ferritin Level in thalassaemia patients N Sultana1, S Sadiya2, MH Rahman1 1Dept. of Biochemistry, Dhaka Medical College, Dhaka 2Dept. of Biochemistry, Dhaka Shishu Hospital, Dhak ABSTRACT Thalassaemia is the most common hereditary disorder in the world including Bangladesh. Beta thalassaemia major and Hb-E thalassaemia both are common in our country. Iron overload causes most of the mortality and morbidity associate with thalassaemia. To assess the iron over load and liver function a cross sectional comparative study was carried out in the Department of Biochemistry, Dhaka Medical College, Dhaka in collaboration with Thalassaemia Center and Department of Pathology, Dhaka Shishu Hospital, Dhaka during the period of July 2006 to June 2007. The study was carried out with the patients who visited regularly in Dhaka Shishu Hospital Thalassaemia Centre (DSHTC) and had multiple transfusions (more than five) and age more than 2 years. To compare the state of liver function with normal healthy individuals' normal healthy persons were also included. Total 70 subjects were included in this study. The study subjects were distributed into two groups, the group - A (cases, n=40) and group - B (healthy controls, n=30). According to the major types of thalassaemia present in our country, group -A again divided into two, group - AI β-thalassaemia major (n=12) and group - AII of Hemoglobin E β-thalassaemia (n=28). The mean of serum Bilirubin in group - A and group - B were (2.04 ±0.70) mg/dl and (0.67±0.15) mg/dl respectively. Group - A had higher serum bilirubin than group -B in p value <0.001.The mean level of serum bilirubin in group - AI was (1.70±0.70)mg/dl and the mean of bilirubin in group AII was (2.18±0.66) mg/dl.
  • Influence of Iron on Bone Homeostasis

    Influence of Iron on Bone Homeostasis

    pharmaceuticals Review Influence of Iron on Bone Homeostasis Enik˝oBalogh 1, György Paragh 2 and Viktória Jeney 1,* 1 Research Centre for Molecular Medicine, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary; [email protected] 2 Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary; [email protected] * Correspondence: [email protected]; Tel.: +36-70-217-1676 Received: 1 September 2018; Accepted: 12 October 2018; Published: 18 October 2018 Abstract: Bone homeostasis is a complex process, wherein osteoclasts resorb bone and osteoblasts produce new bone tissue. For the maintenance of skeletal integrity, this sequence has to be tightly regulated and orchestrated. Iron overload as well as iron deficiency disrupt the delicate balance between bone destruction and production, via influencing osteoclast and osteoblast differentiation as well as activity. Iron overload as well as iron deficiency are accompanied by weakened bones, suggesting that balanced bone homeostasis requires optimal—not too low, not too high—iron levels. The goal of this review is to summarize our current knowledge about how imbalanced iron influence skeletal health. Better understanding of this complex process may help the development of novel therapeutic approaches to deal with the pathologic effects of altered iron levels on bone. Keywords: bone homeostasis; iron overload; iron deficiency; osteoclast; osteoblast; osteoporosis 1. Introduction Bone is a metabolically active tissue that is continuously being remodeled, which enables growth in childhood, as well as repair and adaptation of the skeleton in adults. During bone remodeling, the adult skeleton is renewed approximately once every ten years. The two major cell types involved in bone remodeling are the osteoclasts, with a function of resorption of bone tissue and osteoblasts, with a role of new bone tissue formation.
  • Evaluation of Serum Iron Overload, AST:ALT Ratio and Log10ferritin:AST Ratio Among Schizophrenia Patients in the Kumasi Metropolis, Ghana: a Case-Control Study

    Evaluation of Serum Iron Overload, AST:ALT Ratio and Log10ferritin:AST Ratio Among Schizophrenia Patients in the Kumasi Metropolis, Ghana: a Case-Control Study

    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Research Online @ ECU Edith Cowan University Research Online ECU Publications Post 2013 1-1-2019 Evaluation of serum iron overload, AST:ALT ratio and log10ferritin:AST ratio among schizophrenia patients in the Kumasi Metropolis, Ghana: A case-control study W. K. B. A. Owiredu Peter Kojo Brenya Yaw Osei Edwin Ferguson Laing Clement Opoku Okrah See next page for additional authors Follow this and additional works at: https://ro.ecu.edu.au/ecuworkspost2013 Part of the Medicine and Health Sciences Commons 10.1186/s13104-019-4847-2 Owiredu, W. K. B. A., Brenya, P. K., Osei, Y., Laing, E. F., Okrah, C. O., Obirikorang, C., ... Donkor, S. (2019). Evaluation of serum iron overload, AST: ALT ratio and log 10 ferritin: AST ratio among schizophrenia patients in the Kumasi Metropolis, Ghana: a case–control study. BMC Research Notes, 12, Article 802. Available here This Journal Article is posted at Research Online. https://ro.ecu.edu.au/ecuworkspost2013/7327 Authors W. K. B. A. Owiredu, Peter Kojo Brenya, Yaw Osei, Edwin Ferguson Laing, Clement Opoku Okrah, Christian Obirikorang, Enoch Odame Anto, Emmanuel Acheampong, and Sampson Donkor This journal article is available at Research Online: https://ro.ecu.edu.au/ecuworkspost2013/7327 Owiredu et al. BMC Res Notes (2019) 12:802 https://doi.org/10.1186/s13104-019-4847-2 BMC Research Notes RESEARCH NOTE Open Access Evaluation of serum iron overload, AST:ALT ratio and log10ferritin:AST ratio among schizophrenia patients in the Kumasi Metropolis, Ghana: a case–control study W.
  • GGT) Activity and Indices of Iron Metabolism with Bone-Mineral Parameters in Orthogeriatric Patients Leon Fisher1 and Alexander Fisher2

    GGT) Activity and Indices of Iron Metabolism with Bone-Mineral Parameters in Orthogeriatric Patients Leon Fisher1 and Alexander Fisher2

    Research iMedPub Journals Journal of Biomedical Sciences 2016 http://www.imedpub.com/ Vol.5 No.4:26 ISSN 2254-609X DOI: 10.21767/2254-609X.100040 Relationship between Serum Gamma-Glutamyltransferase (GGT) Activity and Indices of Iron Metabolism with Bone-Mineral Parameters in Orthogeriatric Patients Leon Fisher1 and Alexander Fisher2 1Department of Gastroenterology, The Canberra Hospital, Canberra, ACT, Australia 2Department of Geriatric Medicine, The Canberra Hospital, and Australian National University Medical School, Canberra, ACT, Australia Corresponding author: Leon Fisher, Department of Gastroenterology, The Canberra Hospital, and Australian National University Medical School, Canberra, ACT, Australia, Tel: +61-2-62443738; Fax: +61-2-62444036; E-mail: [email protected] Rec Date: Jun 21, 2016; Acc Date: Jul 18, 2016; Pub Date: Jul 25, 2016 Copyright: © 2016 Fisher L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation: Fisher L, Fisher A. Relationship between serum gamma-glutamyltransferase (GGT) activity and indices of iron metabolism with bone- mineral parameters in orthogeriatric patients. J Biomedical Sci. 2016, 5:4. Keywords: Bone turnover markers; GGT; Iron metabolism; Abstract Fracture; Elderly Purpose: To examine serum levels of GGT activity and Introduction biomarkers of iron metabolism in relation to parameters of bone and mineral metabolism in elderly patients with and The interest in gamma-glutamyltransferase (GGT; E.C.2.3.2.2), without osteoporotic bone fractures in the absence of overt a heterodimeric glycosylated protein embedded into outer liver diseases.
  • Anaemia and Serum Protein Alteration in Patients with Pressure Ulcers

    Anaemia and Serum Protein Alteration in Patients with Pressure Ulcers

    Spinal Cord (1997) 35, 58 ± 60 1997 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/97 $12.00 Anaemia and serum protein alteration in patients with pressure ulcers U Fuoco, G Scivoletto, A Pace, VU Vona and V Castellano IRCCS, Ospedale S. Lucia-Rome, Italy The presence of anaemia and serum protein alteration frequently makes the treatment of pressure ulcers more dicult. Several haemato-chemical parameters were observed in 40 patients with sacral pressure ulcers in order to determine the pathogenesis of these complications. All of the patients showed mild-moderate anaemia with low serum iron and normal or increased ferritin and hypoproteinemia with hypoalbuminemia. Our results suggest that both anaemia and serum protein alteration depend on the chronic in¯ammatory state due to the presence of pressure ulcers. Both anaemia and hypoproteinemia disappeared after pressure ulcer healing. A correct diagnosis is important for the treatment. Iron therapy is useless and potentially dangerous (iatrogenic haemochromatosis) since anaemia is the result of the inability to use iron stores and not iron de®ciency. The treatment of serum protein alterations should be based on a dietary therapy rich in protein and calories; the administration of albumin should be reduced, since albumin is low in essential amino-acids and too expensive; albumin administration should be limited to cases with severe hypoproteinemia and oedema. Keywords: pressure ulcers; anaemia; serum protein alteration; chronic in¯ammatory state Introduction Pressure ulcers are complications which frequently femur. All suered from a sacral pressure ulcer which occur in patients who have been bedridden for a long had persisted for more than 30 days (from 30 days to 6 time.
  • A Case of a 15-Month-Old with Periorbital Edema and Severe Anemia Audrey D

    A Case of a 15-Month-Old with Periorbital Edema and Severe Anemia Audrey D

    A Case of a 15-Month-Old With Periorbital Edema and Severe Anemia Audrey D. Kamzan, MD, Charles A. Newcomer, MD, Laura J. Wozniak, MD, MSHS, Noah C. Federman, MD, Lydia S. Kim, MD, MPH This is the case of a previously healthy 15-month-old girl who initially abstract presented to her primary pediatrician with a 2-week history of intermittent periorbital edema. The edema had improved by the time of the visit, and a urine specimen was unable to be obtained in the clinic. A routine fingerstick demonstrated anemia to 8.8 mg/dL, so the patient was started on ferrous sulfate. She then returned to the emergency department 1 month later with severe periorbital edema and pallor but no other significant symptoms. On physical examination, she was tachycardic with striking periorbital edema and an otherwise normal physical examination. She was noted to have a severe microcytic anemia (hemoglobin of 3.9 mg/dL and mean corpuscular Mattel Children’s Hospital and University of California, Los Angeles, Los Angeles, California volume of 53.1 fL) and hypoalbuminemia (albumin of 1.9 g/dL and total protein of 3.3 g/dL). The remainder of her electrolytes and liver function test Drs Kamzan, Newcomer, and Kim conceptualized this diagnostic dilemma and drafted the initial results were within normal limits. A urinalysis was sent, which was negative manuscript; Drs Wozniak and Federman contributed for protein. Our panel of experts reviews her case to determine a unifying to drafting the initial manuscript; and all authors diagnosis for both her severe anemia and her hypoalbuminemia.
  • Guidelines for the Use of Serum Tests for Iron Deficiency (CLP 002)

    Guidelines for the Use of Serum Tests for Iron Deficiency (CLP 002)

    Guidelines for the Use of Serum Tests for Iron Deficiency (CLP 002) Revised February, 2012 1. Purpose To provide clinicians with a concise reference document describing the appropriate laboratory tests for assessing patients of all ages suspected of having iron deficiency. Investigation of the underlying cause of iron deficiency is beyond the scope of this guideline. Iron overload will be covered in a separate OAML guideline. Readers are reminded that OAML Guidelines will not apply to every clinical situation, nor can they serve as a substitute for sound clinical judgment. 2. Causes of Iron Deficiency: Table 1: Causes of Iron Deficiency Increased Menstruating females Requirements Pregnancy Lactation Growing infants and children Erythropoietin treatment Increased Loss GI bleeding Menorrhagia Persistent hematuria Intravascular hemolytic anemias Regular blood donors Parasitic infections Decreased Intake Vegetarian diet Socioeconomic factors Decreased Upper GI pathology (eg: Celiac and Crohn’s disease) Absorption Gastrectomy Medications (antacids, Zantac) Page 1 of 5 3. Indications for Testing Screening of the general population for iron deficiency is not indicated. At-risk populations as defined in Table 1 with clinical signs and symptoms and patients with microcytic anemia should be considered for screening. It should be noted that although microcytic anemia is often due to iron deficiency, it can also be caused by hemoglobinopathies and anemia of chronic disease. The latter disorders are beyond the scope of this guideline, but should be considered in the differential diagnosis and management. Failure to identify these other causes may result in unnecessary iron replacement. 4. Testing for Iron Deficiency A low serum ferritin result indicates that iron stores are depleted, making serum ferritin the most specific test for iron deficiency and the only test that should be used for screening.
  • Serum Iron and Risk of Diabetic Retinopathy

    Serum Iron and Risk of Diabetic Retinopathy

    nutrients Article Serum Iron and Risk of Diabetic Retinopathy Ying-Jen Chen 1, Jiann-Torng Chen 1, Ming-Cheng Tai 1, Chang-Min Liang 1, Yuan-Yuei Chen 2,3 and Wei-Liang Chen 4,5,6,* 1 Department of Ophthalmology, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; [email protected] (Y.-J.C.); [email protected] (J.-T.C.); [email protected] (M.-C.T.); [email protected] (C.-M.L.) 2 Department of Pathology, Tri-Service General Hospital Songshan Branch, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; [email protected] 3 Department of Pathology, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan 4 Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan 5 Division of Environmental Health & Occupational Medicine, Department of Family & Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan 6 Department of Biochemistry, National Defense Medical Center, Taipei 114, Taiwan * Correspondence: [email protected]; Tel.: +886-2-87923311 (ext. 16567); Fax: +886-2-87927057 Received: 2 July 2020; Accepted: 29 July 2020; Published: 31 July 2020 Abstract: Background: Diabetic retinopathy (DR) is indicated as a major cause of blindness in the world. Emerging evidence supports the interaction of iron metabolism with diabetes. However, little research is available concerning the relationship between iron metabolism and DR. The intent of this paper is to describe the correlation between serum iron and the occurrence of DR.