Diagnostic Use of Serum Ferritin as a Predictor of Hospital Outcome at Admission in Patients with Infective Endocarditis

Background: Infective endocarditis (IE) is characterised by a concentration of infection inside the heart; it is caused by a bacterial or fungal infection of the endocardial surface of the heart; and it is linked with substantial morbidity and death.The aim of this research was to assess serum ferritin as an admission predictor of in-hospital prognosis in subjects with IE. Methods: This case control researchincluded60subjects diagnosed with IEon the basis of the modified duke's criteria.Subjects were allocated equally into two groups: group I: IE subjects who were further subdivided into two groups based on presence or absence of major adverse cardiovascular events (subgroup A: 19 patients who showed IE complications or major adverse cardiac events during hospitalization and subgroup B: 11 patients who showed a smooth course during hospitalization without major adverse cardiac events or IE complications) and IE subjects as well as age and sex matched 30 healthy subjects. Results: serum ferritin level were significantly increased in group I than group II (P value<0.05). Serum ferritin level was significantly increased in subgroup A than subgroup B (P value<0.001). serum ferritin can significantly predict bad outcome (P value<0.001) with AUC of 0.964 (95% CI: 0.881 – 0.995). At cut off >1200, serum ferritin can significantly predict bad outcome with 94.44% sensitivity, 92.86% specificity, 85% PPV and 97.5% NPV. Conclusions: Serum ferritin was significantly increased in IE subjects who experiencedproblems on admission as compared to IE subjects who didn’t.

CORRELATION OF SERUM FERRITIN AND LDH ON CRITICALLY ILL PATIENTS OF COVID-19 DISEASE DURING 1ST AND 2ND WAVE OF COVID 19 PANDEMIC IN TERTIARY CARE HOSPITAL, INDIA

In both the earlier waves of COVID-19 variants, severe and fatal respiratory disease like acute respiratory distress syndrome (ARDS) became more fatal in population with comorbid conditions. Therefore, early identi?cation of severe COVID-19 is very important for individual's precise management, including antiviral, oxygen support and intensive care unit (ICU) management. First case of COVID-19 got reported in the medical record of India on 30th January 2020 in a student who had returned from Wuhan, China. In 2020 and 2021 it was found that individuals with increased serum ferritin and LDH level landed up with severe and very severe COVID-19 if not treated timely and correctly. So correlation between S. Ferritin and LDH in 1st and 2nd wave was required to evaluate the condition of patients who remained admitted in critical care unit with or without comorbid conditions. This is hospital based cross- sectional observational study on 50-50 (total-100) critically ill patients admitted during 2020 and 2021 respectively. We found that In 2020 during the 1st wave serum LDH and serum Ferritin levels were signi?cantly high with the mean value of 481.65 U/L and 532.56 ng/ml respectively and in 2021 during 2nd wave serum LDH and serum Ferritin levels were again signi?cantly high with the mean value of 488.43 U/L and 667.27 ng/ml respectively. In 2020 patients with comorbid conditions showed S. LDH and Ferritin mean value of 543.47 U/L and 582.63 ng/ml respectively and in 2021 during 2nd wave it showed S.LDH and Ferritin levels mean value of 672.72 U/L and 727.38 ng/ml respectively. Both in?ammatory markers were signi?cantly more increased in the critically ill patients who presented with co-morbidities. This study will provide improved con?dence to health workers working in remote areas and COVID-19 hospitals in predicting transfer of COVID-19 patients to tertiary care hospitals for critical care management at the earliest.

ASSOCIATION OF SERUM FERRITIN IN POST COVID-19 ANAEMIC PATIENTS TREATED WITH UMBILICAL CORD BLOOD AND HAEMATINICS.

COVID-19 patients commonly present with lower respiratory symptoms with other systemic involvement. Haematological manifestation such as low haemoglobin, thrombocytopenia, lymphocytopenia also common in COVID19 patients. In this study, we investigated prevalence, association with serum ferritin in post COVID-19 anaemic patients, after human umbilical cord blood transfusion in relation to control group. Among 155 COVID-19 RT-PCR positive patients 36 (23%) was anaemic. In our study 18 patients was transfused human umbilical cord blood, 12 patients were treated with haematinics and 6 patients denied taking any of the above. In most cases anaemia was moderate to severe that may be due to inflammation or due to pre-existing iron deficiency.Umbilical cord blood transfusion to post COVID -19 patients for the treatment of anaemia because of the unique composition of UCB. Haematological analysis and serum ferritin estimation reflecting the treatment out come in post COVID-19 anaemic patients. There was a difference between the dependent variable's serum ferritin (p <.001) in anaemic COVID-19 patients. In conclusion, our result highlight serum ferritin is widely used in diagnosis and monitoring of COVID-19 disease.

Cenário das políticas públicas para hemocromatose hereditária no Brasil / Public policy scenario for hereditary hemochromatosis in Brazil

Resumo Hemocromatose hereditária (HH) é a doença genética mais comum em descendentes de europeus e sua epidemiologia em nosso país é incerta. Considerando o cenário das políticas públicas em HH no mundo contemporâneo, este artigo propõe uma reflexão sobre o tema, com objetivo de fazer uma revisão bibliográfica narrativa sobre a abordagem adotada para essa doença em países desenvolvidos e a nível nacional. Além disso, discute sobre o custo-benefício da incorporação do índice de saturação da transferrina (ST) e ferritina sérica (FS) no nosso sistema de saúde, com a finalidade de identificar a HH antes que surjam suas complicações, bem como seu rastreio em campanhas nacionais de prevenção. O valor gasto para o screening da HH com dosagem de ST e FS pelo Sistema Único de Saúde (SUS) é muito menor do que os custos gerados quando o dano por excesso de ferro já está estabelecido. Nos casos suspeitos de HH, deveria ser viabilizada pelo SUS a pesquisa da mutação genética para o gene HFE, que atualmente só está disponível de forma privada. Com essas medidas, modifica-se a história natural da doença, reduzindo a morbimortalidade dos portadores e custos ao sistema público de saúde.

Abstract Hereditary hemochromatosis (HH) is the most common genetic disease among European descendants and its epidemiology in Brazil is unclear. Considering the contemporary public policy scenario aimed at HH, this narrative bibliographic review reflects on the approach adopted for this disease at the national level in developed countries. It also discusses the cost-effectiveness of incorporating transferrin saturation (TS) and serum ferritin (SF) indexes in the Brazilian healthcare system for early HH identification, as well as its screening in national prevention campaigns. The amount spent on ST- and FS-based HH screening by the Brazilian National Health System (SUS) is much lower than the costs generated by the already established iron overload. In suspected cases, genetic mutation research of the HFE gene, which is currently only performed privately, should be made available by the SUS. These measures can modify the natural history, reducing HH morbidity and mortality and its costs to the public health system.

Research progress on iron nutritional status of plateletpheresis donors / 中国输血杂志

Apheresis platelets are extensively utilized in clinical practice due to high purity and minimal side effects. These platelets are primarily obtained from regular blood donors. However, there is no consensus on whether plateletpheresis leads to iron deficiency among blood donors. In recent years, increasing attention has been given to the impact of plateletpheresis on the iron nutritional status of these donors. Numerous studies have indicated a prevalence of iron deficiency among plateletpheresis donors. The process of plateletpheresis involves the loss of red blood cells, which can accumulate over time and disrupt iron metabolism, ultimately resulting in iron deficiency anemia. This condition not only affects the physical well-being of the donors but also leads to a decline in their willingness to donate blood. Blood collection and supply institutions should enhance their focus on the iron nutritional status of plateletpheresis donors and implement various measures, such as intensifying health education regarding the significance of iron supplementation, implementing programs for testing iron deficiency, considering the provision of iron supplements and extending blood donation intervals. It is crucial to prevent iron deficiency in plateletpheresis donors. These institutions should explore calculation models that can predict personalized blood donation intervals and iron supplementation strategies, and seek a balanced approach that is optimal for maintaining adequate collections while safeguarding donor health. The article comprehensively reviews literature at home and abroad on the etiology and hazards of iron deficiency in plateletpheresis donors, as well as detection methods and response measures. It serves as a foundation for developing scientific and reasonable care measures for blood donation, while also achieving personalized and scientific management and recruitment strategies for blood donors.

Diagnostic value of serum ferritin as an indicator of disease severity in children with dengue infection

Background: Dengue fever is an acute febrile illness, ranging from asymptomatic to severe state in connection with hosts immune response. Several biochemical markers such as decreased platelet count, prolonged prothrombin duration, and increased hematocrit level have been recommended to evaluate disease severity. Due to lack of their clinical relevance, evaluation of serum ferritin is distinguishing feature to predict the disease severity at the early stage of infection. Aims and Objectives: The aim of the study was to assess the levels of serum ferritin as an early predictor of infection severity in children with dengue fever. Materials and Methods: Seventy-four patients diagnosed with dengue fever by non-structural protein 1 antigen positive and ?12 years of age were recruited. Hematological investigation such as platelet count, C-reactive protein (CRP), complete blood picture, liver function tests, renal function tests, and serum ferritin was assessed. Cases were monitored for disease progression status and platelet count too. Categorical variables were assessed by Chi-square test and descriptive statistics were used to represent demographic data. Results: The mean differences of the levels of platelet count, CRP, total cholesterol, triglycerides, and low-density lipoprotein were statistically significant among severe and non-severe dengue cases. Serum ferritin levels in children with severe dengue fever showed 876.42 ng/ml, 1048.94 ng/ml and 1573.20 ng/ml on 3rd, 4th, and 5th day, respectively. Whereas, cases with non-severe dengue showed 431.12 ng/ml, 612.20 ng/ml, and 698.41 ng/ml on 3rd, 4th, and 5th day, respectively. Conclusion: Serum ferritin levels were significantly increased with severity dengue fever on 3rd, 4th, and 5th day of infection. Thus, serum ferritin is an efficient biomarker in estimating the dengue fever severity and progression at early stage of infection in children.

Risk Factors of First Episode Simple Febrile Seizures in Children Aged 6 Month to 5 Year: A Case Control Study

Objective: To study the risk factors of first episode simple febrile seizures in children. Methods: This case control study was conducted at the pediatric department of our tertiary care hospital. Cases were children of age group 6 months to 5 years presenting with first simple febrile seizures (n=214), and Controls were children of same age group presenting with short febrile illness but without any seizures (n=214). Blood investigations were done to diagnose iron deficiency, which was diagnosed by adopting cut off of hemoglobin value <11 g/dL, serum ferritin < 12 ng/mL and red cell distribution width >15%. Other risk factors studied included age, gender, socioeconomic status, prematurity, family history of febrile seizure and epilepsy in first degree relatives, consanguinity, neonatal hospital admissions, day care attendance (for >1 mo), under nutrition, and immunization status of the child. Univariate analysis for crude odds ratio and multivariate analysis (logistic regression) was performed to study the adjusted odds ratio and independent risk factors. Results: The significant risk factors for first episode simple febrile seizure were iron deficiency [OR (95% CI) 5.78 (3.56-9.38); P=0.001], family history of febrile seizure [OR 4.31 (2.37- 7.83), P<0.001] or epilepsy [OR 4.25(2.21-8.19), P<0.001] in first degree relatives, day care attendance for >1 month [OR 4.81 (2.41-9.59), P<0.001], and prematurity at birth [OR 5.18 (2.48-10.84), P<0.001]. Conclusion: Iron deficiency, family history of febrile seizure and epilepsy in first degree relatives, day care attendance and premature birth are the risk factors for first episode simple febrile seizures in children.

A Study of Serum Ferritin Level in Patients of Dengue Fever and Its Correlation with the Severity of Dengue Fever in Tertiary Care Hospital of South Gujarat

Introduction: In more than 100 endemic countries, there are 50 to 100 million new cases reported per year, according to the WHO. The dengue pandemic has caused significant death. There is usually only supportive care offered and no effective therapy. The purpose of the study was assess any effect on the level of serum ferritin in patients of dengue. Methodology: This was an observational, Prospective study conducted at Surat Municipal Institute of Medical Education and Research General Medicine department among dengue fever cases. Result: Serum ferritin level from on admission then on day 3 and then day 5 in non-severe and severe dengue cases showed p value <0.001 which was statically significant. Conclusion: The use of a serum ferritin level alone with a cut-off value of more than 900 ng/ml is indicated.

Pulmonary Function in Children With Transfusion-Dependent Thalassemia and Its Correlation With Iron Overload

Objective: To assess the pulmonary function of children with transfusion-dependent thalassemia, and to correlate its pattern with serum iron status. Methods: Cross-sectional study done in the pediatrics department of a tertiary care hospital from June, 2018 to May, 2019. 66 children aged 5-18 years with ?-thalassemia and HbE/?-thalassemia, admitted for blood transfusion, and with a history of minimum 20 transfusions, were enrolled. Estimation of forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio by spirometer, estimation of serum ferritin and CRP, and chest X-rays were done in all the participants. Results: 53 (80.3%) children had HbE/?-thalassemia, and 47 (71.2%) showed restrictive pulmonary dysfunction. The mean serum ferritin with impaired pulmonary function was 5616 (70.34) ng/mL and serum ferritin level had significant correlation with pulmonary function (P<0.001). Conclusion: Restrictive pattern of pulmonary dysfunction was common in children with thalassemia, and body iron status had a significant association with pulmonary impairment.

Correlation of Vitamin D Levels with COVID-19 Severity and Outcome

Background and aims: Low vitamin D levels have been associated with an increase in inflammatory cytokines and a significantly increased risk of pneumonia and viral upper respiratory tract infections. Vitamin D deficiency is associated with an increase in thrombotic episodes, which are frequently observed in coronavirus disease 2019 (COVID-19). These conditions are reported to carry a higher mortality in COVID-19. So, we conducted a study to prove the correlation of vitamin D levels with COVID-19 infection and severity. Material and methods: The present study was conducted at RNT Medical College, Udaipur, Rajasthan. This study was done over a period of 2 months after getting approval from Institutional Ethics Committee. Written and informed consent was obtained from patients. In this study, 81 patients admitted in COVID wards and ICU, with COVID reverse transcriptase-polymerase chain reaction (RT-PCR) positive reports were included. Results: Out of a total 81 patients, 37 (45.7%) were in the 41-60 years age group, 29 (35.8%) were more than 60 years of age and 15 (18.5%) were less than 40 years of age. Seventeen patients had severe vitamin D deficiency, 27 patients had moderate vitamin D deficiency, 20 patients had mild vitamin D deficiency and 17 patients had normal vitamin D level. Out of 17 patients who had severe vitamin D deficiency, 11 (64.7%) patients required invasive mechanical ventilation and out of these 17 patients, 13 (76.47%) patients died. Out of 17 patients who had normal level of vitamin D, 16 (94.1%) maintained SpO2 at room air and only 1 patient required invasive mechanical ventilation. As the level of vitamin D increased from severely low to normal level, requirement of high oxygen support decreased and SpO2 at room air increased. Mean of vitamin D among the patients who died was 10.4963 while mean of vitamin D level among patients who survived and were discharged was 27.2362. All 17 patients who had normal level of vitamin D were discharged from the hospital. Mean of serum ferritin and mean of interleukin (IL)-6 was high in patients who died and low in patients who were discharged. Conclusions: Vitamin D level plays an important role in COVID-19 disease. Vitamin D have significant role in protection from severe form of disease.

Mucormycosis and Its Co-Relation with Raised Ferritin Levels

Background: Mucormycosis has emerged as an epidemic within the COVID-19 pandemic due to widespread use of corticosteroids and immune-modulators like Tocilizumab, in the management of COVID-19 pneumonia. It is an invasive fungal disease which spreads by angioinvasion and rapidly spreads to adjacent tissues. If untreated its outcomes are dangerous and often fatal. Uncontrolled diabetes, malignancies and dialysis are predisposing factors. Raised blood iron is an important factor in pathogenesis and rapid progression of fungal invasion that needs to be investigated. Aim: To establish a correlation between raised serum ferritin level and aggressiveness of Mucormycosis. Methodology: Aretrospective study was done from February 2021 to February 2022 of patients diagnosed with mucormycosis by middle meatal biopsy and microscopy along with CT& MRI scan of PNS with brain. They were treated either surgically or conservatively. All the blood parameters including serum ferritin level, were carried out. Acomparison was done on extent of disease in patients in-relation to their serum ferritin level. Results: Our study suggested that higher levels of ferritin are often associated with aggressive form the disease. Zygomycetes are dependent on environmental iron for their growth. Higher the serum ferritin level, more aggressive & widespread is mucormycosis. Conclusion: Serum free iron aggravates mucormycosis. Measures should take to control the serum ferritin in patients under risk for mucormycosis. Iron chelating agents or novel methods like anti-ftr1 immune serum should be developed for controlling the disease at its earlier stages

Correlation of serum ferritin levels with pulmonary function tests in thalassemia patients

Background: Iron overload is an inevitable complication of thalassemia. Pulmonary function test (PFT) abnormalities have been described but the results of the studies correlating serum ferritin levels with PFTs have shown inconsistent results. Aims and Objectives: The objectives of the study were (1) to determine the frequency of PFTs abnormalities and (2) to correlate serum ferritin levels with PFTs. Materials and Methods: PFTs were done in 50 patients with thalassemia over 8–27 years of age using spirometer. Mean serum ferritin level in the preceding 1 year was taken. Results: PFTs were normal in 54%, restrictive in 34%, obstructive in 10%, and combined restrictive and obstructive in 2% of the patients, respectively. There was inverse correlation between serum ferritin and FEV1 and FVC but it was not statistically significant. Conclusion: Abnormalities of PFTs are common in thalassemia patients. Inverse relation of serum ferritin with FEV1 and FVC may indicate possible role of iron in the etiopathogenesis of PFTs abnormalities but its significance needs to be evaluated further.

Serum ferritin and glycated hemoglobin in type 2 diabetes mellitus: A case–control study

Background: High body iron stores have been linked to insulin resistance, metabolic syndrome, and gestational diabetes. Complications of diabetes mellitus are influenced not only by its duration but also by average level of blood glucose, the latter can be monitored by glycated hemoglobin. Aim and Objective: The aim of this study was to study the relationship of serum ferritin and glycated hemoglobin in type 2 diabetes mellitus. Materials and Methods: The case–control study was undertaken on 100 subjects, both males and females; age 35–70 years; categorized into two groups: Group 1 (Cases = 50 patients of type 2 diabetes mellitus [T2DM]) and Group 2 (Controls = 50 healthy, non-diabetic individuals). Results: Fasting blood glucose, serum ferritin, and glycated hemoglobin values were 178.96 ± 37.16 mg/dL, 261.29 ± 76.98 ng/dL, and 9.37 ± 1.44%, respectively, in T2DM cases, while the corresponding values were 95.06 ± 12.68, 90.75 ± 67.53, and 4.81 ± 0.88 in healthy controls. Conclusion: Increased levels of serum ferritin were seen in T2DM and significant correlation between blood sugar and serum ferritin was found.

Prospective study of relationship between serum ferritin and metabolic associated fatty liver disease / 中华健康管理学杂志

Objective:To investigate the relationship between serum ferritin (SF) and metabolic associated fatty liver disease (MAFLD).Methods:A total of 7 980 adults from physical examination in Tianjin Medical University General Hospital who met selection criterion were recruited as participants. Subjects were divided into 4 groups ( Q1- Q4) according to quartiles of SF level by gender. The incidence of MAFLD in each group in 2018-2020 were observed and cumulative incidence of MAFLD was compared between each group. Cox regression model was used to analyze the correlation between different SF levels and new-onset MAFLD, and stratified analysis was performed according to factors as gender, age, smoking status and body mass index (BMI). Results:The mean follow up period was 3.2 years, and there were 25 323 person-years of follow-up, and 1 696 subjects developed MAFLD. The incidence density of MAFLD in Q1- Q4 groups were 53.30, 56.39, 72.80 and 85.78/1 000 person-years, respectively. The incidence density of MAFLD increased along with the increase of SF levels, and the differences were statistically significant ( P values between Q3, Q4 and Q1 groups were both<0.001) with SF ≥ 162.47 μg/L (male) and 49.94 μg/L (female). The risk of MAFLD were 1.173 (95% CI: 1.093-1.258) and 1.174 (95% CI: 1.122-1.228) times higher in Q3 and Q4 group than that in Q1 group ( P<0.001). After adjusting for age, smoking status and other confounding factors, the risks of MAFLD in the Q3 and Q4 groups were 1.092 (95% CI: 1.017-1.172) and 1.084 (95% CI: 1.035-1.136) times higher in Q3 and Q4 group than that in Q1 group (all P<0.001). The stratified analyses based on gender, age, smoking status, BMI and other factors indicated that high SF levels showed significant association with MAFLD risk in those with the male sex, younger age, non-smokers and higher BMI population. Conclusions:High SF levels might increase the risk of MAFLD and this positive association might be associated with gender, age, smoking status and BMI.

Progress of serum ferritin and its relationship with infection / 国际儿科学杂志

Ferritin is a polymeric protein composed of different ferritin subunits to store iron in the human body.It is involved in maintaining iron balance inside and outside the cell.Iron balance is disrupted by internal and external factors after infection.Studies have shown that ferritin is significantly elevated during infection and may affect the prognosis of the disease.However, due to insufficient understanding of ferritin, the study on ferritin is rarely in the clinic.This article aims to review the relationship between serum ferritin and infection from the aspects of the ferritin cycle, iron disturbance during infection, prediction, and prognosis of serum ferritin in infectious diseases, and provide a reference for further research.

Serum ferritin level and the influencing factors in premature infants / 中国新生儿科杂志

Objective:To study the levels of serum ferritin (SF) in preterm infants of different gestational ages and analyze the influencing factors.Method:From October 2018 to October 2020, preterm infants hospitalized in our hospital were included for prospective study. According to the gestational age, the infants were assigned into 3 groups: 34~36 w group, 32~33 w group and <32 w group. The SF levels were compared among the groups and the influencing factors were analyzed.Result:A total of 919 preterm infants were included, including 481 in the 34~36 w group, 293 in the 32~33 w group and 145 in the <32 w group. The incidence of Cesarean section in the <32 w group was lower than the other two groups ( P<0.001). The incidence of twin birth in the 32~33 w group was higher than the other two groups ( P<0.05). No significant differences existed in gender among the three groups ( P>0.05). The serum SF levels in the 34~36 w group, 32~33 w group and <32 w group were (240.1±167.4), (216.2±137.0) and (204.4±112.8)μg/L, respectively. The serum SF levels in the 34~36 w group were higher than the other two groups ( P<0.05). No significant differences existed in serum SF levels between the 32~33 w group and the <32 w group ( P>0.05). Multiple　linear　regression　analysis　showed　that SF levels were lower in premature infants with small gestational age and Cesarean section delivery ( P<0.05). Conclusion:SF levels in premature infants with small gestational age and Cesarean section delivery are lower and more monitoring of SF are needed.

Influencing factors for anemia in the third trimester of pregnancy / 预防医学

Objective @#To explore the influencing factors for maternal anemia during the third trimester of pregnancy, so as to provide the evidence for the effective prevention of anemia.@*Methods @#Data of parturients, who received prenatal care and delivered at Hangzhou Women＇s Hospital from October to December of 2019 were retrospectively collected and analyzed. The obstetric electronic medical record system of this hospital was used to collect general information of the subjects. Serum ferritin, serum vitamin B12, serum folic acid and hemoglobin were determined at the second and third trimester. A multivariate logistic regression model was used to analyze the influencing factors for anemia in the third trimester. @*Results @#A total of 1 143 parturients were enrolled, with a median age of 29 ( interquartile range: 4 ) years. Among them, 1 050 cases had normal weight before pregnancy, accounting for 91.86%; 267 cases were multiparas, accounting for 23.36%; 74 cases of anemia occurred during the third trimester of pregnancy, accounting for 6.92%.Multivariate logistic regression analysis indicated that the multipara（OR=1.714,95%CI: 1.032-2.848）, iron deficiency duiring the second trimester（OR=3.301,95%CI: 1.401-7.781）, iron deficiency during the third trimester （OR=14.134,95%CI: 1.944-102.774）and folate deficiency during the third trimester（OR=2.960,95%CI: 1.295-6.766）were influencing factors for anemia during the third trimester.@*Conclusion@#Anemia during the third trimester of pregnancy is related to iron deficiency during the second and third trimesters, folic acid deficiency during the third trimester, and multipara.

Serum Ferritin and the Risk of Metabolic Syndrome: A Systematic Review and Dose-Response Meta-Analysis of Cross-sectional Studies / 生物医学与环境科学（英文）

Objective@#This study aims to assess the dose-response relationship between serum ferritin (SF) and metabolic syndrome (MetS) in the two sexes.@*Methods@#We searched for articles on PubMed, the Cochrane Library, EMBASE, and the Web of Science databases that were published from 1950 to 2020. The summary odds ratio ( @*Results@#This study included 14 studies and 74,710 samples. The results of the classical meta-analysis showed that SF was positively associated with MetS ( @*Conclusions@#Our study shows that SF is significantly and positively associated with MetS, and the risk in the male population is higher than that in the female population. This finding also supports the recommendation of using SF as an early warning marker of MetS.

Changes of serum iron and ferritin in regular voluntary blood donors / 中国输血杂志

【Objective】 To study the effect of regular blood donation on the serum iron (SI) and serum ferritin (SF) of regular blood donors. 【Methods】 A total of 240 blood samples (4~5 mL per person, with EDTA-2K anticoagulant) from regular voluntary blood donors in our center from January to June 2019 were randomly selected as the study group. Another 200 healthy subjects without blood donation history were randomly selected as the control group. SI was measured by Ferene method, SF by chemiluminescence method, and blood routine indexes by automatic hematology analyzer. 【Results】 The Hb, RBC count, HCT and other blood routine indexes of the study group and the control group were all in the normal range. SI (mol/L) in the study gourp and the control group was 17.13±4.36 vs 17.82±5.78(P>0.05), and SF (ng/mL) was 98.34±52.74 vs 147.52±91.52 (P<0.05). 【Conclusion】 SI and SF may decrease due to regular blood donation, which deserve close follow-up to ensure the safety of regular blood donors.

Non-purulent pharyngitis: adult still’s disease

 Adult Still’s disease is rare and may present as pyrexia of unknown origin. Due to lack of expertise, diagnosis may be delayed inadvertently. The patient usually presents with spiked fever, polyarthralgia or arthritis, evanescent skin rash, non-purulent pharyngitis, lymphadenopathy and hepatosplenomegaly. Leukocytosis, predominantly of neutrophils, elevated erythrocyte sedimentation rate and C-reactive protein without obvious infection are the hallmarks of the disease. Delay in diagnosis may expose the patient to the side effects of antibiotics as they are repeatedly prescribed in view of elevated leukocytes. The majority of patients report pain in the throat without evidence of infection. This was an important clue to our diagnosis of this patient. Grossly elevated serum ferritin is diagnostic of adult onset still's disease. As the white cell counts are grossly elevated, a bone marrow examination to rule out hematological malignancy may be mandatory. Serum ferritin value has prognostic value too. Minor illness may respond to non-steroidal anti-inflammatory drugs (NSAIDs), but steroids are the mainstay of the treatment.  Methotrexate is of additional value for those presenting predominantly with arthritis. Anakinra, Infliximab and Tocilizumab are other options. Those patients presenting with severe disease and organ involvement require high dose intravenous steroids followed by high dose oral steroids.