A study of association of serum ferritin as a prognostic marker in acute cerebrovascular accident

Cerebrovascular disease (CVD) is the third leading cause of death in developed countries and is now emerging as the commonest preventable life-threatening neurological problem worldwide. It makes an important contribution to morbidity and mortality in developed as well as developing countries. The prognosis of acute stroke is determined by a series of factors some of which may be used in the early stages of stroke to predict prognosis and mortality. However, the role of inflammatory markers in predicting functional outcome in stroke remains controversial, Iron and ferritin are known to have an important role in stroke as well as in other disorders. Serum ferritin which is considered as an acute phase reactant has also been used for assessing the severity and prognosis of stroke. Therefore, testing of serum ferritin is useful in identifying high risk patients.1: To study the effect of level of serum ferritin with early neurological deterioration and the outcome in patients of acute stroke. 2: Association of serum ferritin in ischemic and haemorrhagic stroke.50 patients with acute stroke were selected based on inclusion and exclusion criteria. Appropriate questionnaire was used to collect the data of patients. Diagnosis of stroke was confirmed by CT or MRI scan of brain and examination was done by Canadian stroke scale at the time of admission. About 5ml of venous blood Sample from cubital vein was collected for measuring serum ferritin levels, it was performed within 48hrs of onset of symptoms by using CLIA method. Neurological assessment was repeated on the day of discharge to assess the clinical improvement and prognosis of the stroke patients.Totally 50 patients of acute stroke were included in our study, majority of the patients are males 35 (70%), and females are 15(30%). Approximately 36% were in the age group of 51-60 years. In this study ischemic stroke was seen in 45 (90%) of the patients and 5 (10%) had hemorrhagic stroke. The serum ferritin levels are normal in 41(82%) and high in 9(18%) of the patients. Canadian stroke scale interpretation on the day of discharge showed 20% of the patient are deteriorated, 66% are in the same status and 14% of the patients are improved clinically. The patients with haemorrhagic stroke had high serum ferritin level 60.0% and ischemic stroke are 13.3%. Those patients with high serum ferritin levels had higher deterioration in Canadian stroke scale (p<0.001). The mean serum ferritin levels are higher in deteriorated patients 199.29% when compared to other status group in Canadian stroke scale.High levels of serum ferritin correlates well with early neurological deterioration of stroke patients. Based on this study finding, that high serum ferritin level within 48 hours after the onset of symptoms of stroke helps to predict the early prognosis. Therefore, testing of serum ferritin is useful in identifying high risk patients.

Association of Body mass index and serum ferritin level in pediatrics with Beta-thalassemia major disease

Background: Beta-thalassemia major is a type of inherited blood disease that results in variable outcomes such as severe anemia due to haemoglobin chains. Recurrent and lifelong blood transfusions as a treatment in beta-thalassemia major disease lead to iron deposition in various organs and cause the failure of multiple organs. Failure of affected organs leads to Body mass index (BMI) abnormality. This study aimed to evaluate the association between BMI and serum ferritin level as a marker for iron overload. Materials and Methods: A cross-sectional study designed and conducted with total number of 740 paediatrics, with mean age about 14.2±8.7 years old and with beta-thalassemia major requiring recurrent blood transfusion. Patient information, including demographics, serum ferritin level and percentage of BMI, was recorded and analysed by SPSS 25.0 and the statistical significant level, considered as 0.05. Results: A total number of 740 paediatrics with beta-thalassemia major disease (mean age about 14.2±8.7 years) were included to study to examine the association between serum ferritin level and their BMI. The total mean serum level of ferritin calculated about 3326 ± 3859 Nanogram/mililitter (ng/ml). Totally, 447 (60.4%) case of them had BMI percentile less than 5%, 274 (37.02%), 16 (2.16%) and 3 (0.4%) had BMI percentile 5%-85%, 85%-95% and more than 95%. There was no relation between gender and serum ferritin levels. The relationship between age and BMI has been positive (P=0.002). Finally, it resulted that there was a negative relationship between the BMI percentile and mean serum ferritin levels in paediatrics with beta-thalassemia major (P=0.031). Conclusion: Frequent Blood transfusion is associated with elevated serum ferritin level in paediatrics with beta-thalassemia major disease and experiencing lower percentiles of BMI in these patients.

An Analytical Study to Explore Iron Stores in a Population of Nowshera Based on Age and Gender Perspective

OBJECTIVES: To analyze the impact of age and gender on iron stores in a population of the Nowshera region. METHODOLOGY: This cross sectional study was conducted in the Department of Pathology Qazi Hussain Ahmed Medical Complex Nowshera from 1st January 2019 to 31st March 2020. All patients were selected by convenience sampling in the Pathology department irrespective of age and gender. Both descriptive and inferential statistics were applied to analyze data by the latest SPSS version 25. RESULTS: Out of the total study population males were 70 (27.1%) and females 188 (77.9%) with median age 30 years. The median ferritin level was 12.8 ng/ml. Out of total, 142 (55%) of cases were with serum ferritin less than 15ng/ml. A significant (p=0.03) gender based median ferritin level difference was observed with 1.5 times more probability of low iron stores in females as compared to males (OR=1.5). No statistically significant difference in body iron stores exists in different age groups. CONCLUSION: A significant difference was noted in the iron stores in gender groups and the probability of depleted/low iron stores was higher in female gender as compared to male gender in all age groups in our population.

Clinical Characteristics of Female Patterned Hair Loss in Patients Attending Hair Clinic in Thailand

Objective: To study the clinical features and associated factors of female pattern hair loss (FPHL) in premenopausal and menopausal women patients. Materials and Methods: This is a retrospective chart review of FPHL patients visited hair clinic, Siriraj Hospital from June 2012 to May 2015. Demographic data, family history and history of hair loss were evaluated. Factors associated with FPHL were analysed. Results: There were 267 patients (180 premenopausal women and 87 menopausal women) in this study. The mean age of onset of patients was 35.5±12 years (premenopausal FPHL) and 60.5±7 years (menopausal FPHL). Positive family history of androgenetic alopecia (AGA) was 48.3%, mainly in first-degree relatives. The data showed an increased incidence of FPHL with advancing age. The most common presentation is Ludwig grade I. The study showed that patients also have dyslipidemia (16.9%), hypertension (16.5%), diabetes mellitus (10.9%), hypothyroidism (4.9%), anemia (3.7%), and hyperthyroidism (2.9%). In multivariate analysis, significant associations were found between low ferritin level < 70 µg/L and premenopausal FPHL (OR 5.51, 95% CI 2.26-15.14, P = 0.01). Conclusion: Maternal family history of AGA seems to have a greater influence on premenopausal FPHL. Low serum ferritin levels < 70 µg/L were significantly associated with FPHL in premenopausal women.

Increased Risk of Poor Clinical Outcome in COVID-19 Patients with Diabetes Mellitus and in-hospital Mortality Predictors: A Retrospective Cohort from a Tertiary Hospital in Indonesia

Aim: To determine association between diabetes in confirmed cases of COVID-19 and intensive care admission and in-hospital mortality, evaluate several laboratory parameters as mortality predictor, and develop predictors of in-hospital mortality among diabetics with COVID-19. Methods: This retrospective cohort recruited all cases of COVID-19 hospitalized in Fatmawati General Hospital during March to October 2020. Inclusion criteria was RT-PCR confirmed cases of COVID-19 who aged 18 years and older while exclusion criteria were incomplete medical record or cannot be found and pregnant women. Results: We enrolled 506 participants to this study with median age of 51 years (IQR:22), female (56.32%), and diabetes (28.46%). Diabetes increased intensive care admission (adjusted OR:6.07;95%CI:3.52-10,43) and in-hospital mortality (adjusted OR:50;95%CI:1.61-3.89). In predicting in-hospital mortality, ferritin and lactate dehydrogenase offered an acceptable discrimination, AUC:0.71 (95%CI: 0.62-0.79) and AUC:0.70 (95%CI: 0.61-0.78), respectively. The optimal cut-off of predicting mortality for ferritin was 786 g/mL and for LDH was 514.94 u/L. Factors include age above 70 years old, RBGs level on admission above 250 mg/dL or below 140 mg/dL, ferritin level above 786 ng/mL, and presence of ARDS increased the odds of mortality among individuals with diabetes. Conclusions: Diabetes increases risk intensive care admission and in hospital mortality in COVID-19. Multivariate analysis showed that older age, RBG on admission, high ferritin level, presence of ARDS increased the odds of mortality among individuals with diabetes.

Incidence of iron deficiency anemia among the children with febrile seizures.

Objective: To determine frequency of iron deficiency anemia among the children having febrile seizures. Study Design: Descriptive Cross Sectional study. Setting: Pediatric Unit Allama Iqbal Memorial Teaching Hospital Sialkot. Period: September 2020 to February 2021. Material & Methods: Total 70 children were studied with age six months to 10 years with either gender presenting with febrile seizures. All data of the patients was documented including demographic data like age, gender, residential area, educational status, socioeconomic status and clinical findings at the time of presentation like fever, fits and duration of symptoms etc. Blood hemoglobin and ferritin level were tested of each patient to evaluate iron deficiency anemia. Results: There were 65.7% male and 34.3% female cases in this study. Age range of the patients was 6 months to 10 years with mean age of 4.36 ± 2.71 years. Most of the children (60%) were below three years of age. Mostly children belonged to low and middle socioeconomic status with the frequency of 42.8% and 45.7% respectively. Iron deficiency anemia was found in 38.6% cases. Majority of the mothers were illiterate (65%). There were 44.3% cases from rural areas and 55.7% from urban area. Conclusion: Iron deficiency anemia is a common problem among children with febrile seizures, younger than 03 years and belonging to rural areas. Illiterate mothers, is an important risk factor of iron deficiency anemia in their children.

DIAGNOSTIC SIGNIFICANCE OF MEASURING RETICULOCYTE MATURITY INDICES IN IRON DEFICIENCY ANAEMIA

Objective: To evaluate the diagnostic significance of reticulocyte maturity indices in iron deficiency anaemia. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi, from Sep 2019 to Jun 2020. Methodology: A total of 340 children, ages between 1 and 5 years of either gender, were divided into two groups based on haemoglobin and ferritin level. Group A comprised of 203 children with haemoglobin >11 g/dL andferritin level >7 ng/ mL. Group B comprised of 137 children with haemoglobin <11g/dL and ferritin <7 ng/mL. Red blood cell and reticulocyte parameters were compared. Results: Iron deficiency anaemia was found to be 37.6% in the study population. Comparison revealed that the children in groups B had significantly higher mean red cell distribution width (17.1 ± 1.3% vs. 13.3 ± 1.3%) and significantly lower hemoglobin (9.5 ± 1.0 g/dL vs. 12.7 ± 1.0 g/dL), mean corpuscular hemoglobin (21.8 ± 2.5 pg vs. 28.6 ± 2.3 pg), mean corpuscular volume (69.4 ± 3.5 fL vs. 80.4 ± 3.3 fL), mean corpuscular hemoglobin concentration (31.5 ± 1.8 g/dL vs. 32.7 ± 1.6 g/dL) and serum ferritin level (4.5 ± 2.6 mg/mL vs. 55.9 ± 32.1 ng/mL). No significant differences in the mean total red blood cell count, hematocrit and reticulocytes between two groups were noted (p>0.05) and significant differences were noted in terms of low, medium & high fluorescence ratios in both groups (p<0.05). Conclusion: Our findings suggest that medium fluorescence ratio and high fluorescence ratio.......

Increased Serum Ferritin Levels in Type 2 Diabetes Mellitus Patients: A Hospital Based Cross-Sectional Study

INTRODUCTION: Type 2 diabetes mellitus is a metabolic disorder of multiple etiology characterized by chronic hyperglycemia with a derangement in carbohydrate, fat and protein metabolism resulting from defects in insulin secretion and action. Ferritin is a ubiquitous intracellular protein complex that reflects the iron stores of the body. Studies have shown that the increased body iron stores are associated with the development of glucose intolerance often leading to metabolic syndrome and type 2 diabetes (T2DM). The objective of the study was to find out association of serum ferritin level with T2DM and assess the correlation between serum ferritin and HbA1c. MATERIAL AND METHODS: A hospital based comparative cross-sectional study was conducted in 43 diabetic patients and 42 age and sex matched healthy controls. Fasting blood glucose (FBG), postprandial blood glucose (PBG), Glycated hemoglobin (HbA1c) and serum ferritin were estimated in cobas c311 autoanalyser using standard protocol. RESULTS: Mean age of healthy control and T2DM were found 54.83 ± 6.48 and 55.95±10.92 years respectively. Mean FBG (mg/dL) (170.41 ± 71.7 v/s 98.38 ± 9.7), PBG (mg/dL) (266.16 ± 110.09 v/s 123.20 ± 17.0), HbA1c (%) (8.17 ± 1.83 v/s 4.9 ± 0.29 and median ferritin (μg/L) 207.90 (138, 306.0) v/s 127.95 (85.75, 210.25) were significantly higher in T2DM compared to the healthy controls. Spearman’s correlation depicted that ferritin level was positively correlated with HbA1c level but the correlation was statistically insignificant. CONCLUSION: Serum ferritin level was found significantly higher in T2DM compared to healthy age and sex matched controls in our study.

Serum Ferritin Concentration in Corona Virus Disease 19

Introduction: Coronavirus disease 19 (COVID-19) is a complex disease responsible for the development of exacerbated inflammatory response (cytokine storm) that ultimately leads to multiorgan failure and death. Serum ferritin has been recently identified as one of the inflammatory markers responsible for the pro-inflammatory effects. Small amount of ferritin is present in plasma (15-150 ng/mL) which might increase with the severity of COVID-19. Therefore, measurement of ferritin is essential in identifying disease severity and predict disease prognosis. Objective: This study aims to assess the ferritin level in COVID-19 patients. Methods: A cross-sectional study was carried out on 259 COVID-19 patients visiting KIST Medical College and Teaching Hospital (KISTMCTH), Lalitpur, Nepal from November 2020 to April 2021. Serum ferritin was estimated in the automated Siemens ADVIA Centaur CP Chemiluminescence Immunoassay system. All the patients visiting KISTMCTH referred by clinician for ferritin assessment were included in this study. Data collected using the proforma tool was tabulated in SPSS 21 and statistical analysis was done by inferential statistical test. Results: Out of total 259 COVID-19 patients, 58.7% were male and the majority of patients (82.6%) were below 70 years of age. The mean age for all participants was 52.11±16.59 years. Hyperferritinemia was seen in 218 (84.16%) COVID -19 patients. The mean value of serum ferritin was 767.1±789.86 (IQR: 12.8-4590) ng/mL and was significantly higher in males (p<0.001). Comparing the mean values of ferritin between the patients below and above 70 years, no statistical difference was observed (p=0.872). Conclusions: In our study, serum ferritin levels were greatly increased in patients with COVID-19 infection. Keywords: Coronavirus disease 19; cytokine storm; inflammatory marker; serum ferritin.