Longitudinal study of growth parameters in beta-thalassemia major on oral iron chelation

Children with thalassemia suffer from growth retardation. It had mainly been attributed to iron overload in the tissues and endocrine glands, chronic anemia, hypersplenism, folic acid deficiency, delayed or absent puberty. In addition a direct toxic effect on the bones has been observed in patients, before and during puberty, receiving continuous subcutaneous chelation therapy. The aim of this work is to monitor the growth of children with beta-thalassemia on oral iron chelation for early detection of growth and pubertal disorders. In this study, auxological, pubertal and laboratory data of 82 patients with beta-thalassemia major on hypertransfusion regimen and adjusted oral iron chelation following up at the hematology clinic at Cairo University Children's Hospital are studied. Height, weight, Body Mass Index, and US/LS ratio were followed up on a 3-monthly basis, over a period of 4 years. Height velocity and bone age were assessed yearly. Serum ferritin, thyroid including free T3, freeT4 and TSH and parathyroid functions including serum calcium, albumin, alkaline phosphatase and parathormone, folic acid, vitamin B12 levels, were measured in 38 of the cases at the end of the study and compared to 20 age and sex matched control. In this study 24/82 [29%] of the patients are short and remained so during the study. The US/LS ratio was abnormal in 17 cases [21%] and the ratio normalized in 7 by the end of the study. Bone age improved by the second year and returned slowed down thereafter. 52% of adolescents suffered pubertal delay and 35% needed HCG replacement to induce puberty. Serum ferritin, B12 and folic acid, Parathormone, calcium, phosphorus, alkaline phosphatase, free T3, T4, TSH were significantly different from controls. Patients in this series are hypocalcemic, hypoalbuminemic, with 65% B12 and 71% folic acid deficient, 8% had preclinical hypothyroidism while 34% had clinical hypothyroidism, one third are short and half of them have delayed puberty. The stature is not correlated to thyroid status. There was a significant correlation of height SDS and folic acid and albumin. Upper segment/Lower segment ratio was correlated to serum albumin, calcium and parathormone. Short stature is common among thalassemic patients. Puberty is delayed in half of them. Egyptian children with thalassemia are hypocalcemic, hypoalbuminemic, with an increased incidence of hypothyroidism, B12 and folic acid deficiency. Emphasis must be put on an adequate, balanced nutrition in these children with increased cell turn over

Effect of partial parenteral versus enteral nutritional therapy on serum indices in multiple trauma patients

Malnutrition is a common complication in multiple trauma patients because of the metabolic and catabolic increase and negative nitrogen balance. It may deteriorate patients' outcome. Some clinical and paraclinical parameters are used for nutritional assessment. In this study our goal was evaluation of nutritional parameters in enteral and partial parenteral methods for detecting the better method of nutritional support. This prospective study had done during 30 months on 80 multiple trauma patients with 4[th] to 10[th] GCS [Glascow Coma Scale] at the end of the first day of admission. They divided into 2 groups randomly: we used partial parenteral nutrition in the first group [41 patients] and enteral nutrition in the second one [39 patients]. We studied serum total protein, albumin, transferrin and total lymphocyte count during their first two weeks of hospitalization. In the first group, they received more protein and calorie during 14 days. Serum total protein, Albumin and transferrin were more statistically significant in this group [P < 0.05]. In partial parenteral nutrition patients will receive more protein and calorie, and they will have more total serum protein. It seems that parenteral-enteral nutrition prepares better paraclinical nutritional parameters

Iron status of first year medical students at Gezira University

To determine the iron status of first-year medical students at Gezira University and identify influence of ethnic group and gender on the iron status. Cross-sectional community based study. The sample consisted of 160 students aged 16-20 years with a mean [ +/- SD] age 18.56 +/- 0.94 of both sexes [70 = males, 90 = females]. Blood samples were collected from each student and questionnaire was completed. Haemoglobin [Hb], packed cell volume [PCV], serum iron and total iron binding capacity were determined by cyanomethaemoglobin method, microhaematocrit centrifuge and colourmetric methods respectively. Mean corpuscular haemoglobin concentration [MCHC] and transferrin saturation were calculated. The mean [ +/- SD] concentration of Hb, serum iron and transferrin saturation of all male students was 14.86 +/- 1.29 g/dL, 102.46 +/- 30.5 micro g/dL and 39.72 +/- 11.23% respectively. The mean [ +/- SD] concentrations of Hb, serum-iron and transferrin saturation of all female students was 12.57 +/- 0.92 g/dL, 57.51 +/- 11.8 micro g/dL and 21.12 +/- 5.4% respectively. Haemoglobin level, serum-iron and transferrin saturation were within normal levels according to WHO criteria. There were significant differences between mean values of biochemical parameters and sex of students and father income P<0.05. There was no significant association between iron status parameters and family size and ethnic groups. There was positive correlation between subject iron status and diet [meat, liver, fruits and hilba]. Iron status of first-year medical students at Gezira University is within normal reference values. This is in line with the health status of the students

Iron deficient children and significance of serum ferritin

To evaluate the significance of serum ferritin in iron deficiency anaemia as compared to other indices. Children were selected as anaemic and non-anaemic on the basis of hemoglobin [10g/dl] and transferrin saturation [15%]. Red cell morphology, hemoglobin, serum iron, TIBC, transferrin saturation and serum ferritin were determined. Red cell morphology was of little significance. Haemoglobin, serum iron, transferrin saturation and serum ferritrin were all lower in children. A positive correlation of serum ferritin with age, haemoglobin, serum iron and transferrin saturation and a negative correlation with TIBC was found. Serum ferritin was more sensitive indicator as compared to serum iron, TIBC, and transferrin saturation

Determinants of circulating soluble transferrin receptor level in chronic renal failure patiets

Anemia is a common problem in chronic renal failure [CRF] especially in patients under maintenance haemodialysis [HD] therapy. Soluble transferrin receptors [sTfR] is useful for quantitative assessment of erythropoiesis in HD patients but its specificity for detection of iron-defficient erythropoiesis in HD patients with recombinant human erythropoietin [rHuEpo] therapy is insufficient, even inconclusive and controversial. So the assessment of iron-deficient erythropoiesis is a hard task in HP patients during rHuEpo therapy. We designed this work aiming at identification of factors determining the sTfR level in CRF patients predialysis or on haemodialysis with and without rHuEpo therapy. Fifty CRF patients were studied who were divided into 3 groups:- Group I: 10 patients on conservative treatment.- Group II: 10 patients on regular HD but not on rHuEpo therapy.- Group III: 30 patients on regular HD and on rHuEpo therapy. We studied also two other groups, group IV: 10 anemic patients with normal kidney function and group V: 10 apperantly healthy control. We measured in all subjects sTfR level, s. Epo, transferrin saturation [TS%], s. ferritin, s. iron, TIBC, C-reactive protein, hypochrornic red cell percentage [HRC°/o] reticulocytic count and CBC. sTfR level was significantly raised in group III [dialysis with Epo] compared to group I [predialysis] [P < 0.01] and to group H [dialysis without Epo] [P < 0.0l]. sTfR was also significantly raised in group IV [anemic non uremic] compared to CRF groups [predialysis [P < 0.01], dialysis without Epo [P < 0.0l] and dialysis with Epo [P < 0.05]]. Haemodialysis patients with rHuEpo were stratified by less than 25. 25-75 and more than 75 percentiles of serum ferritin, by < 20 and > /= 20% of TS as well as by < 10 and > /= 10% of HRC%. The levels of sTfR in patients of lower quartile [mean +/- SD 4.9 +/- 1.5 micro g/l] was higher than those with upper quartile [mean +/- SD 2.23 +/- 0.78 micro g/l] and these with 25-75 percentile [mean +/- SD 2.48 +/- 0.69 micro g/l]. In CRF patients under dialysis with Epo there was significant positive correlation between sTfR versus basal Epo [P < 0.01], HRC% [P < 0.01], retics% [P < 0.01], Hct [P < 0.0l] and Hb [P < 0.01] but was significantly negative correlated versus TS [P < 0.01] and S.Ferritin [P < 0.01]. Multivariate regression analysis disclosed that HRC%, serum ferritin, Hct and TS% were the four independent predictors of sTfR levels and accounting for [68%] of the variability in sTfR. So, sTfR levels quantitatively reflects tile integrated effects of iron availability [HRC% and TS%], iron reserves [serum ferritin] and markers of erythropoiesis [Hct] and we conclude that sTfR levels is a good index of monitoring iron deficiency and erythropoietic activity in CRF especially those under HD therapy and receiving rHuEpo and it reflected the integrated effects of iron availability, iron reserves and erythropoietic stimulation

Evaluación bioquímica del estado nutricional en un grupo de puérperas. Estudio preliminar / Biochemical evaluation of nutritional status in a group of puerperal women. Preliminary study

Se determinaron los niveles de proteína transportadora de vitamina A, transtirretina (prealbúmina), transferrina, inmunoglobulina A, fracción C3 de complemento en suero y de inmunoglobulina A total en saliva, en un grupo de 109 mujeres durante los primeros días post-parto. Las muestras de sangre y saliva no estimulada de las pacientes en ayunas se mantuvieron a -20 ºC hasta ser analizadas por inmunodifusión radial en placas de agarosa. Los resultados (media ± DE), expresados como porcentaje de las proteínas totales, fueron: 0,06 ± 0,02; 0,24 ± 0,06; 6,36 ± 1,19; 2,70 ± 0,47 y 3,76 ± 1,17 para proteína transportadora de vitamina A, transtirretina, transferrina, C3 e IgA sérica respectivamente, mientras que los de IgA en saliva fueron de 14,3 ± 10,3 mg/dL. Los valores de proteína transportadora de vitamina A y transtirretina fueron significativamente menores a los de referencia, lo que sugeriría un posible estado nutricional materno deteriorado que no se reflejó en el peso de los recién nacidos

Study of the binding of iron and indium to human serum apo-transferrin

Indium is a heavy metal belonging to group IIIa. It is believed that indium may interfere with iron metabolism from the sites of absorption, transportation, utilization and storage in the cells. The present investigation was established to study and compare the binding of iron and indium to human apo-transferrin [apo-tf]. Pure human apo-tf was used and the binding activity of iron and indium, as a complex with citric acid [1:20], to apo-tf was studied. The binding of iron and indium to apo-tf in Tris-HCl buffer, pH 7.4 showed a maximum absorbance at 465 and 255 nm, respectively. The binding of both metals to apo-tf appears to be pH dependent. Using equilibrium dialysis technique, the binding of iron to apo-tf and the effect of indium on the binding process were also studied. Addition of indium to the outside of dialysis sac reduced iron uptake by 37%. The results indicate that indium competes with iron in binding to apo-tf. Although, the binding sites for these two ions seem to be similar, the binding of iron to apo-tf is more tightly than indium

Serum determination of the level of iron, ferritin and transferrin in pregnant patients and their relation to preterm delivery

Seventy-five women presenting with preterm labor whose gestational age ranged from 26 to less than 37 weeks were chosen as the study group. Another 75 women were used as a control group [25 women whose gestational age ranged from 38 to 40 weeks presenting in labor and the other 50 women with gestational ages ranged from 27 to 37 weeks attending the antenatal clinic and were not in labor]. 5 ml venous bloods were withdrawn from the anti-cubital vein from each woman, 2 ml for hemoglobin and 3 ml for serum assay of iron, ferritin and transferring determinations. The results revealed that the concentration of serum ferritin was higher in preterm group and the differences were statistically significant. However, the differences between concentrations of serum iron and serum transferrin among these groups have no significance. In conclusion, the differences of serum iron and transferrin has no significant value in cases of preterm labor, hut the difference in serum ferritin has a good significant value in cases of preterm labor, thus elevation of serum ferritin in the second trimester can be used a predictor of early spontaneous preterm labor

Effect of blood transfusion versus erythropoietin injection on peripheral erythropoietin response in burnt patients

Twenty-seven adult burned patients [burn size 20-40% of total body surface area] were included in this study. The studied patients were blindly and randomly assigned into two groups: Group A [15 patients] received blood transfusion according to their need, while group B [12 patients] received 4000 units of r-HuEPO twice weekly for one month. Blood transfusion was given to both groups when haemoglobin level decreased to less than 8 g/dl. The effect of administered blood transfusion or r-HuEPO was evaluated through clinical response, blood count, reticulocytic count, serum iron and transferrin and erythropoietin level. The mean values of hemoglobin, packed red cell volume and RBCs count of both groups were progressively decreased, especially in the 3rd post burn day. Despite the progressive decrease of all the previous hematological values in both groups, they had elevated serum erythropoietin level allover the post burn period, which was significantly higher in group B. Moreover, significant reticulocytosis was observed, especially in group B. Before the administration of either blood transfusion or r-HuEPO, iron levels were within the normal range, then rapidly reached extremely low levels and remained low throughout the study periods in group B. On the contrary, in group A, serum iron levels were rapidly increased and reached high levels and remained high throughout the study periods. Moreover, serum ferritin levels were rapidly reaching supernormal values and remained higher allover the study, but the level of transferrin was low in the follow up period compared with that of the first days. The study concluded that recombinant human erythropoietin [r-HuEPO] is capable of enhancing erythropoiesis and has lower risk of iron overload than frequent blood transfusions in burned patients

Effect of exchange transfusion on oxygen free radicals and some antioxidants in newborn infants

Exchange transfusion rapidly produces variable changes in pro-oxidants and antioxidants plasma concentrations in neonates which may be responsible for free radical metabolism. So our study aimed to evaluate the effect of exchange transfusion on some pro-oxidants [iron, and ferritin] and primary antioxidants [ceruloplasmin and transferrin] in newborn infants. The study included 25 neonates [16 males and 9 females] with mean gestational age of 34.4 +/- 3.9 weeks. They were divided into 2 groups according to clinical presentation, 17 with hyperbilirubinemia [6 haemolytic and 11 non haemolytic] and 8 hyperbilirubinemia with sepsis. All neonates were subjected to full clinical history, Gestational age assessment, thorough clinical examinations for all systems and laboratory investigations [before and after exchange transfusion] in the form of complete blood count, serum levels of total and direct bilirubin, serum levels of ferritin, Iron and T.I.B.C., serum level of malondialdehyde and serum levels of ceruloplasmin and transferrin.Regarding to our results, serum level of total bilirubin showed statistically highly significant decrease after exchange transfusion [E.T.] and primary antioxidant [ceruloplasmin and transferrin] were significantly elevated after E.T. As regard pro oxidants, there was highly significant decrease in serum levels of ferritin, iron and malondialdehyde after E.T. and highly significant rise in serum level of T.I.B.C. after E.T. The differences between the mean values of serum ferritin, iron, T.I.B.C., transferrin and - ceruloplasmin before and after exchange transfusion were statistically significant in preterm and neonates with birth weight less than 2kg. Transferrin showed positive correlation with gestational age.After exchange transfusion there was significant decrease in serum levels of ferritin and iron and significant increase in T.I.B.C. in both groups of neonataI hyperbilirubinemia and neonatal hyperbilirubinemia with septicemia. Serum levels of transferrin and ceruloplasmin were also increased after exchange transfusion in both groups but without significant statistical difference. Finally we can conclude that elevation of serum levels of primary antioxidants [ceruloplasmin and transferrin] and lowering serum levels of oxygen free radicals [MDA as an index] after exchange transfusion indicate its important role not only in decreasing the serum bilirubin level but also in improving the defence mechanism against oxygen free radical injury especially in preterm neonates. Preterm and neonates with low birth weight are more vulnerable to neonatal oxygen radical diseases because of their developmentally low iron associated antioxidant proteins [transferrin]

Study of serum transferrin, homocysteine, and nitric oxide in preeclampsia and its relation to serum lipid peroxidation

To investigate serum lipid peroxides, and some of the antioxidants [glutathione peroxidase activity and serum transferrin] as well as to measure serum homocysteine and total nitrites as an index of serum nitric oxide in preeclampsia and normal pregnancy. Twenty nulliparous subjects who had preeclampsia [PE] were recruited in this study. Twenty women who had uncomplicated pregnancies and age matched, were included as control group. These control women were normotensive, throughout gestation and without proteinuria. Patients with cigarette use, chronic hypertension, renal or metabolic disease or previous history of metabolic disorders were excluded. Fasting serum samples were obtained before delivery [AP] and 24 hours postpartum [PP]. The separated serum was investigated for serum iron and total transferrin concentration. Percent saturation of iron-binding capacity is measured as [serum iron/total iron binding capacity X 100]. Determination of serum lipid peroxides and homocysteine were done. The activity of glutathione peroxidase in red cell hemolysate was also determined. Total nitrites was measured as an index of nitric oxide concentration, in the maternal circulation of normal pregnant women and women with preeclampsia. Serum lipid peroxides were elevated in PB women relative to normal pregnant women controls before delivery [p<005] and decreased after delivery in women with preeclampsia compared with antepartum level [p<005]. There was no significant difference with normal pregnant postpartum level. Serum iron was significantly increased in PE pregnant women compared with normal pregnant women [p<0.05] and it decreased significantly after delivery compared with predelivery level in PE women [p<005]. Serum transferrin level was significantly reduced in pregnant women with PE as compared with normal pregnant women [p<0.05]. After delivery, serum transferrin concentration was significantly reduced in PB women [p<0.001] and normal controls [p<0.001] as compared to the corresponding antepartum levels and in PE women compared to PP normal pregnant women [p<0.05] Transferrin percent saturation was significantly elevated in pregnant women with PB as compared with normal pregnant controls. [p<0.05]. After delivery, transferrin percent saturation was significantly decreased in PP PB women compared with PE AP level [p<0.05]. In controls, there was no significant difference in PP level of transferrin saturation as compared with normal AP level or PP PB level. Glutathione peroxidase enzyme activity was significantly reduced in PE pregnant females compared with normal pregnant controls [p<0.05]. Homocysteine level was found to be significantly elevated in PB females compared with normal pregnant controls. [p<0.001] After delivery, serum homocysteine level was significantly reduced in PE females compared with PE AP level [p<0.001] but still was significantly higher than normal postpartum controls [p<0.001]. Serum total nitrites was significantly increased in PE pregnant females as compared to normal pregnant controls [P<0.05]. After labour, it was significantly reduced compared to PB Ap level [p<0.05] A significant positive correlation as observed between percent transferrin saturation and serum lipid peroxides in normal pregnancy before and after delivery [[r= 0.42, p<0.01], [r= 0.37, p<0.01] respectively]. In preeclampsia, the same parameters exhibited a highly significant positive correlation before and after delivery [[r=0.62, p<0.001], [r=0.45, p<0.001]]. Hyperhomocysteinemia and the increase in serum iron as well as the increased serum transferrin saturation in preeclampsia, are factors that increase oxidative stress coupled to an impaired ability to detoxify peroxides as evidenced by reduced glutathione peroxidase activity. The increased oxidation stress might interfere with the bioavailability of nitric oxide in preeclampsia

Validity of red blood indices in screening for iron deficiency anemia in exclusively breast fed infants

Iron deficiency anemia [IDA] is a public health problem of widespread prevalence in developing countries. The rapidly growing infants are the most vulnerable to iron deficiency if they are not supplemented with sufficient iron during weaning. The aim of this work is to study the importance of red cell distribution width [RDW] and RDW-MCV [mean corpuscular volume] combination in the diagnosis of iron deficiency anemia. Infants within the age group 6-12 months who were exclusively breast fed for the first six months attending the pediatric outpatient clinic of Suez Canal University Hospital, Ismailia, were assessed for full nutritional history, general examination, hemoglobin level, MCV, mean corpuscular hemoglobin concentration [MCHC], RDW, serum ferritin [SF], serum iron [SI], transferrin saturation [Trns.S%] and total iron binding capacity [TIBC]. The study revealed that in the anemic blood group [based on a hemoglobin level less than 10 g/dL]. RDW had a high sensitivity, specificity and efficiency as a diagnostic test for IDA [83.3%, 67.2% and 86.6% respectively] and that RDW-MCV in combination were 95% sensitive, 83.3% specific and 92% efficient for the diagnosis of IDA. In conclusion, diagnosis of iron deficiency anemia can be made more accurately and with less expense by combining hemoglobin level measurement with MCV and RDW

Urinary iron children with nephrotic syndrome

Urinary transferrin loss is a typical feature in relapse of the idiopathic nephrotic syndrome [I.N.S.], also, there is increased urinary iron in animals and humans with nephrotic syndrome. Urinary N-acetyl-beta-D- gluosaminidase [NAG] is indicator for renal damage. To estimate the urinary iron and urinary NAG in children with idiopathic nephrotic syndrome, and the possible role of iron in the different histopathological types of the disease. Our study was performed on 2 groups of patients, minimal change nephrotic syndrome [MC NS] group 10 children [6 boys and 4 girls] mean age 9.75 +/- 2.2 years, focal segmental glomerulosclerosis. [FSGS] group 8 children [5 boys and 3 girls] mean age 9.63 +/- 1.9 years with 12 children [7 boys and 5 girls] of matched ages as a control group. Laboratory parameters hemoglobin concentration [HB], serum albumin, serum iron, serum ferritin, serum transferrin, serum creatinine, BUN, urinary protein per 24 H, urinary transferrin, urinary iron and urinary NAG were evaluated. The results proved decrease in HB in both group of N.S., decrease serum albumin, serum iron, serum ferritin and serum transferrin in both groups of N.S. especially FSGS and significant increase in urinary protein per 24H, urinary transferrin, urinary iron and urinary NAG in both groups of N.S especially FSGS group. There was an increased urinary transferrin and this is accompanied by corresponding increase in a reactive iron species and this could incite tubulo-interstitial injury and renal damage. Measuring urinary iron and urinary NAG could be a respectable method for follow up and prediction of the prognosis in children with idiopathic nephrotic syndrome

Serum iron, ferritin and transferrin in patients with ischemic heart disease

To shed more light on the relationship between ischemic heart disease and iron, serum iron parameters [iron, ferritin and transferring] were estimated in fifty ischemic heart patients [15 stable angina-15 crescendo angina and 20 acute Myocardial Infarction. MI]. Their ages ranged 43-58 years- Ten healthy subjects, matched with patients for age and sex, sevred as control group. Echocardiographic studies [ejection fraction [EF] and end systolic volume [ESV] together with peak serum creatine phosphokinase [CPK] were done for each case of infarction to correlate these variables with the corresponding serum iron parameters. compared to controls, ischemic heart patients had highly significant increase of serum iron [103.5 +/- 25.6 vs 79.6 +/- 19.2, p<0.01] and serum ferritin [94.7 +/- 54.2 vs 44.4 +/- 11.0. p<0.01] whereas they showed insignificant increase of serum transferrin [273.8 +/- 83.8 vs 244.1 +/- 56.4, p<0.05]]. Subgroup analysis showed that there was statistically significant increase in serum iron and ferritin but not transferrin in patients with stable and unstable angina while in cases with acute MI, there was significant increase in all serum iron parameters. correlation studies showed that serum iron and ferritin but not transferrin were strongly correlated with peak CPK. EF and ESV. Patients with acute MI who had complicated in-hospital course showed significant higher value of serum iron. ferritin. transferrin, CPK and ESV but they had a significant lower EF than non-complicated cases. In conclusion, serum iron and ferritin were significantly higher in ischemic heart patients while serum transferrin was significantly higher only in patients with acute MI In the infarction group, the higher the serum iron and ferritin, the larger is the size of infarction, the worser is the in-hospital course and the more impaired is the systolic function. Thus, the present study might give a new meaning for the emerging role of iron in ischemic heart disease

Study on the latent iron deficiency in patients with trichuriasis

Trichuriasis is an intestinal parasitic disease which is caused by Trichuris trichiura, a soil transmitted helminth. In order to evaluate the iron status of trichuriasis in patients a total of 120 [49 males and 71 females] cases with Trichuris trichiura as well as 54 healthy individuals were evaluated. Blood samples were analyzed for serum iron, transferrin saturation%, haemoglobin and other haematological indices. Anaemia based on haemoglobin level less than 13 mg/dI in males and less than 12 mg/dI in females were found in 10 [7 males and 3 females] patients. Of remaining 110 non anaemic patients 11% [14.3% of males and 8.8% in females] would be classified as iron deficient by serum iron and 6% by transferrin saturation%. These findings suggest that serum iron and% transferrin saturation are valid and sensitive tests for detecting iron deficiency in these patients; and T.trichiura infection is associated with high incidence of iron deficiency

Transferrin and the prediction of spontaneous bacterial peritonitis

Patients with advanced liver disease are particularly susceptible to spontaneous bacterial peritonitis [SBP]. Pathogenic micro-organisms could survive and become more virulent in the presence of free iron. Thus, iron binding proteins provide protection against these organisms. The present study was conducted to evaluate the role of determining transferrin levels in serum and ascitic fluid, as well as its serum: ascitic fluid ratio [mg/mg] in differentiating between SBP and SA [sterile ascites] in cirrhotic patients. Moreover, the role of the ratio between ascitic fluid transferrin: ascitic fluid total protein [mg/g], as a marker for SBP was tested. Our study included 50 patients. Twenty five patients had SBP [according to Runyon's and Hoefs criteria] while the other 25 patients had SA. Our results revealed that patients with advanced liver impairment had higher susceptibility for SBP than SA. They had significantly higher serum total bilirubin [p<0.001] and significantly lower serum albumin and transferrmn [p<0.001, respectively]. More over, SBP group had significant prolongation of the prothrombin time [p<0.001]. Ascitic fluid aspirated from the SBP patients showed significantly lower transferrin and total protein values [p<0.05 and <0.001, respectively]. Serum: ascitic fluid transferrin ratio [mg/mg] was significantly lower in patients with SBP [p<0.001]. The best cut off level giving the highest diagnostic sensitivity and specificity was 3.5 yet, at this level poor diagnostic sensitivity and specificity in differentiating between the two clinical conditions [76% and 28%, respectively] was found. Ascitic fluid transferrin: ascitic fluid total protein ratio [mg/g] was significantly higher in patients with SBP [p<0.001] and had a diagnostic sensitivity and specificity of 100%, respectively in differentiating between both clinical conditions at a cut-off level of 22.26. Patients with advanced liver disease are more liable for the occurrence of SBP than SA. Ascitic fluid transferrin: ascitic fluid total protein ratio, at a cut-off level of 22.26, can differentiate between the two clinical conditions with a diagnostic sensitivity and specificity of 100%, respectively

Iron binding capacity and transferrin saturation in pregnancy

To find changes in the iron status in relation to total iron binding capacity and% saturation of transferrin in pregnant women. Design: Comparative study of haemoglobin, serum iron, serum iron binding capacity [TIBC] and saturation of transferrin in 1st, llnd and lllrd trimester of pregnancy with age matched non-pregnant women. Setting: Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Subjects: Ninety pregnant women, at various stages of pregnancy, all having haemoglobin values below 12 g%, were selected. Result: Values of Hb were found to be significantly lower as compared to the control in all the trimesters of pregnancy. Serum iron and% saturation of iron showed a significant decrease; while total iron binding capacity and unsaturated iron binding capacity showed a significant [P<0.001] increase in the second and third trimesters of pregnancy as comapred to matched control. Total serum iron binding capacity and% iron saturation of transferrin are more sensitive indices of iron stores of an iron deficient pregnant mother at an earlier date, thus preventing anaemia

Glucose metabolism in chronic viral hepatitis B and C

There have been recently observed an association between chronic hepatitis C infection and diabetes mellitus. This association appears independent of impaired glucose tolerance oftenly observed in cirrhosis. In this study, 40% of patients with CHC had either overt diabetes mellitus [20%] or impaired glucose tolerance [20%]. Glucose tolerance was normal in all patients with CHB. We selected non-obese patients with no history of diabetes mellitus; and had no cirrhosis on liver pathology. The glucose intolerance or diabetic state in our cases may be due to the presence of insulin resistance; as we find a higher level of basal C-peptide, serum iron level and transferrin saturation in patients with CHC as compared to patients with CHB. The association of chronic hepatitis C and diabetes mellitus needs further evaluation

Effect of acute inflammatory response to maximal and submaximal exercise on iron-related indices

Twenty male subjects were studied to evaluate the effect of inflammatory response on iron status after maximal and submaximal exercises aiming to identify the appropriate intensity with minimal effect on iron status. The resting levels of the iron related indices were within normal range, whereas, after submaximal and maximal exercises, a fall in serum iron [-28.23%+15.31, - 27.4%+10.14], percent transferrin saturation [-25.71% +/- 12.5, - 33.77% +/- 13.65] and serum ferritin [-2.46% +/- 6.32, - 3.66% +/- 5.63] and a rise in the white cell count [59.5% +/- 13.31, 74.59%+10.12] with release of lactoferrin [73.47% +/- 27.28, 88.6+27.94] were noted. These changes were attributed to the known actions of interleukin-1 [IL-1] being one of the mediators of acute inflammatory reaction as evidenced by the positive correlations found between interleukin-1 and lactoferrin levels both after submaximal and maximal exercises. Moreover, positive correlation was observed between minute oxygen consumption [VO[2]] and [IL-1] level after both types of exercises denoting that the more the subject is fit the more he withstands the tissue hypoxia. The percent changes in serum lactoferrin, white blood cells and interleukin-1 due to maximum exercise were significantly higher when compared with the corresponding values after submaximal exercise. We conclude that although both maximal and submaximal exercises stimulate the acute phase response, yet the submaximal exercise exerts a less harmful effect on iron indices