Iron deficiency anemia and COVID-19

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a significant health and financial issue in the current century. Despite significant attempts to manage the illness, the transmission routes of the virus and its widespread genomic mutations have led to an increasing number of new infections and mortality rates. In the absence of specific treatment for this new virus, identifying and managing factors affecting the prognosis of the disease is one of the critical strategies to reduce disease mortality. Patients with iron deficiency anemia (IDA), who account for an estimated half a billion people globally, are more prone to infections due to immune system disorders. Since they visit hospitals more frequently for follow-up care and diagnosis, they are more susceptible to becoming infected with SARS-CoV-2. Once infected with SARS-CoV-2, low hemoglobin (Hb) levels and compromised immune systems disrupt the restriction of infection in these individuals, ultimately leading to severe complications of COVID-19.

Ferritin - novel uses of a well-known marker in paediatrics

Serum ferritin is one of the most widely used laboratory tests and is associated with both iron deficiency and iron overload. Currently, more and more attention is paid to the involvement of ferritin in processes other than iron metabolism. Low serum ferritin is unanimously associated with iron deficiency, while elevated serum ferritin may be a consequence of various medical conditions such as iron overload, an inflammatory process, SARS-CoV-2, organ failure, cancer, and endocrine disorders, including metabolic syndrome. We present a review of the literature on the role of ferritin in a variety of less obvious disease states in children.Copyright © 2023 Termedia Publishing House Ltd.. All rights reserved.

Managing Severe Acute Asthma Exacerbation in Pregnancy during the COVID-19 Pandemic: A Case Report from a Resource-limited Setting

BACKGROUND: One-third of pregnant women will experience worsening asthma requiring emergency hospitalization. However, no report comprehensively discussed the management of asthma attacks in pregnant women in impoverished settings. We attempt to illuminate what general practitioners can do to stabilize and improve the outcome of severe acute asthma exacerbations in primary care with resource limitations. CASE REPORT: A nulliparous 29-year-old woman in her 21st week of pregnancy presented severe acute asthma exacerbation in moderate persistent asthma with uncontrolled asthma status along with gestational hypertension, uncompensated metabolic acidosis with a high anion gap, anemia, respiratory infection, and asymptomatic bacteriuria, all of which influenced her exacerbations. This patient was admitted to our resource-limited subdistrict hospital in Indonesia during the COVID-19 pandemic for optimal stabilization. Crystalloid infusions, oxygen supplementation, nebulized beta-agonist with anticholinergic agents, inhaled corticosteroids, intravenous methylprednisolone, broad-spectrum antibiotics, subcutaneous terbutaline, mucolytics, magnesium sulphate, oral antihypertensives, and continuous positive airway pressure were used to treat her life-threatening asthma. After she was stabilized, we referred the patient to a higher-level hospital with more advanced pulmonary management under the supervision of a multidisciplinary team to anticipate the worst scenario of pregnancy termination. CONCLUSION(S): Limitations in primary care, including the lack of sophisticated intensive care units and laboratory panels, may complicate challenges in managing severe acute asthma exacerbation during pregnancy. To enhance maternal-fetal outcomes, all multidisciplinary team members should be well-informed about key asthma management strategies during pregnancy using evidence-based guidelines regarding the drug, rationale, and safety profile.Copyright © 2023 Muhammad Habiburrahman, Triya Damayanti, Mohammad Adya Firmansha Dilmy, Hariyono Winarto.

17th Annual Sickle Cell and Thalassaemia Conference

The proceedings contain 115 papers. The topics discussed include: clinical and genetic predictors of sickle cell nephropathy in Malawi;clinicohematological characteristics of iron deficiency anemia and hemoglobinopathies in Pakistan;an experience of non-hospital based laboratory;assessment of hematological parameters of petrol filling workers at petrol stations in Ethiopia: a comparative cross-sectional study;burden and risk factor to acute myocardial ischemia in children with sickle cell anemia;dyslipidemia in transfusion-dependent-thalassemia patients and its correlation with serum vitamin D level;impact of COVID-19 pandemic to pre-transfusion hemoglobin level and frequency of transfusion in transfusion-dependent thalassemia patients in Indonesia;retinopathy in Egyptian patients with sickle cell disease;and dietary pattern, socio-demographic characteristics and nutritional status of pregnant women attending Barau Dikko teaching hospital and the need to develop recommended dietary allowance and dietary reference intakes for sickle cell disease patients.

THE IRON WOMAN PILOT STUDY: A DOUBLE BLIND RANDOMISED TRIAL to COMPARE INTRAVENOUS or ORAL IRON REPLACEMENT to PLACEBO INTRAVENOUS or ORAL THERAPY for IRON DEFICIENCY ANAEMIA in PREGNANCY

Background: Treatment of iron deficiency anaemia (IDA) involves replenishing body iron stores either intravenously (IV) or orally. Previous studies of IV iron in pregnancy have been unblinded, which creates potential for bias measuring primary outcomes. We aimed to determine the feasibility of blinding pregnant women with IDA to IV iron (brown solution) compared to oral iron. Method(s): Two-arm, placebo-controlled randomised trial, with blinding of patients, clinicians and outcome assessors, at 2 Sydney maternity hospitals, 2021.2022. Pregnant women, .18 years of age, 26.32 + 6 weeks' gestation, with mildmoderate IDA (Haemoglobin 80.104 g/L and Ferritin <30 mug/ L), planning to give birth at one of the study hospitals were included. Women were randomised to either (1) a single IV ferric carboxymaltose 1000 mg infusion plus daily placebo oral capsules, or (2) oral capsules 80 mg elemental iron daily and a single placebo intravenous saline infusion, from treatment allocation to birth. Result(s): The study closed after recruiting 16/50 (32%) planned women, at a median gestation of 30 weeks. The baseline median haemoglobin was 101.5 g/L [interquartile range (IQR) 99.0-103.75 g/L] and baseline median ferritin was 11.5 mug/L [IQR 8.0-17.5 mug/L]. Two thirds of women (69%) correctly determined their treatment allocation on the infusion day, increasing to 87% at 4 weeks post infusion (100% of women IV iron). Median,[IQR] haemoglobin increased to 116 g/L, [113-120] and 110 g/L, [104-114] at 4 weeks in IV and oral iron groups respectively. Compliance, acceptability and side effects were measured. Conclusion(s): Blinding of women to IV iron was not successful at 4 weeks post-infusion. Trial recruitment was delayed and interrupted by COVID.

General Measures for the Treatment of Pulmonary Arterial Hypertension According to the New Guidelines

Treatment of PAH involves a multidisciplinary approach that includes general measures. Supervised exercise and rehabilitation, diuretics, vaccination against influenza, pneumococcus and SARS-CoV-2, iron administration for iron deficiency anaemia, and in-flight O (2) administration for low oxygen saturation are now clearly recommended. No general recommendation can be made for the use of anticoagulation, the choice of an anaesthetic procedure, the use of cardiovascular drugs or the administration of long-term oxygen administration. Treatment choices should be based on individual decisions involving a PH expert centre. The management of women of childbearing potential with PAH is complex and requires comprehensive counselling, psychological support and close medical care regarding risks of and alternatives to pregnancy, contraception, as well as multidisciplinary support for existing or desired pregnancy and abortion.

8th International Multidisciplinary Course on Iron Deficiency

The proceedings contain 37 papers. The topics discussed include: Are normal iron and hemoglobin levels needed for acquiring innate immunity and optimizing responses to COVID-19 vaccination?;management of iron deficiency in PBM: the pandemic's barriers;iron deficiency and celiac disease;treating iron deficiency in patients with ulcerative colitis;iron deficiency anemia in children: risk factors, prevention, diagnosis and therapy;iron therapy in children with inflammatory bowel disease (IBD);iron supplementation in pediatric patients with primary iron deficiency anemia: An IRIDA clinical case;iron-deficiency anemia and functional capacity in post-cardiac surgical patients: comparison between two martial treatments;iron prophylaxis in pregnant women and pregnancy outcomes;patient blood management: Anemia in obstetrics;and clinical safety and efficacy of iron supplementation in cancer patients.

Achieving a sustainable food supply, for good health and planetary health, a focus on the international context

Globally, diet quality is poor, with populations failing to adhere to national dietary guidelines.(1) Such failure has been consistently linked with poorer health outcomes.(2) Examples of malnutrition include both under- and over-nutrition, with overweight and obesity now a significant health problem worldwide.(3) Other commonly occurring examples of malnutrition are micronutrient deficiencies with iron, vitamin A and iodine deficiencies being the most frequently occurring globally. These nutritional challenges have been influenced by recent global world events, including the COVID-19 pandemic, the war in Ukraine and the related economic uncertainties;with all of these events influencing food supply and food security. Diet and health status is socio-economically patterned, and such inequalities are likely to have been enhanced as a result of these recent events. In addition to the impact of diet on health outcomes it is increasingly recognised that what we eat, and the resulting food system, has significant environmental or planetary health impacts, and research activity is growing in terms of understanding the detail of these impacts, what changes are required to reduce these impacts and also how the impact of climate change on our food supply can be mitigated. Given the complexity of the interactions between climate change, other world events, food and health, and the different actors and drivers that influence these, a systems thinking approach to capture such complexity is essential.(4) Such an approach will help address the challenges set by the UN 2030 Agenda for Sustainable Development in the form of the Sustainable Development Goals, which are a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice and prosperity.(5) Progress against SDGs has been challenging with an ultimate target of 2030. While the scientific uncertainties regarding diet and public and planetary health need to be addressed, equal attention needs to be paid to the structures and systems, as there is a need for multi-level, coherent and sustained structural interventions and policies across the full food system/supply chain to effect behavior change. Such systems-level change must always keep nutritional status, including impact on micronutrient status, in mind. However, benefits to both population and environmental health could be expected from achieving dietary behaviour change towards more sustainable diets.

Application of a Novel Swallowable Telemetric Device for Real Time Luminal Blood Detection to Guide Timing of Enteroscopy in a Patient with Obscure-Occult Gastrointestinal Bleeding: A Case Report

Background and aim: Gastrointestinal (GI) bleeding is deemed "obscure" when upper and lower GI endoscopy reveal no bleeding site. While the term "overt" is used in cases where visible blood passage is observed or reported, cases without macroscopic bleeding stigmata are defined "occult". Although small bowel origin accounts for only about 5% of all GI bleedings, it makes up the majority of obscure GI bleedings. Diagnostic work-up and treatment of small bowel GI bleedings can be challenging, especially when overt bleeding symptoms are absent. Material(s) and Method(s): We report the case of a frail patient with multiple comorbidities and evidence of bleeding small bowel angiodysplastic lesions on videocapsule assisted enteroscopy (VCE). Device assisted enteroscopy (DAE), planned in order to treat the bleeding lesions, was delayed after the patient contracted SARSCoV- 2 infection. Eight weeks after, in the absence of clinical signs of bleeding, a device for real time luminal blood detection (HemoPillR acute, Ovesco) was applied to guide timing of enteroscopy. Result(s): The 71 year old male patient was on dual anti platelet therapy and had persistent clinical features of iron deficiency anemia (Hemoglobin 8,0g/dl). Upper and lower GI endoscopy were negative for potential bleeding sources. VCE showed three small lesions suspect for angiodysplasia within 1 to 13 minutes after pylorus passage. Upon recovery from SARS-CoV-2 infection and congestive heart failure with respiratory insufficiency, we administered HemoPillRacute orally, without previous bowel preparation. The measurement showed a peak HemoPillR-Index (HI max) at 1h 47min after capsule administration (Fig. 1) and was therefore indicative of a small bowel bleeding site, best approachable by antegrade oral route, in keeping with the prior VCE findings. On subsequent DAE, performed through spiral enteroscopy, the small bowel angiodysplastic lesions were successfully treated. [Figure presented] Conclusion(s): Our case report illustrates how a novel telemetric blood detection measurement was able to confirm luminal blood presence and successfully guide timing of therapeutic DAE in a patient with obscure-occult GI bleeding, without the need for repetition of VCE.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.

Applying principles of patient blood management during COVID-19 pandemic: a literature review

As of 15 December 2021, coronavirus disease 2019 (COVID-19) affected approximately 271 million and killed 5.3 million people globally. COVID-19 pandemic had a tremendous impact on world healthcare systems and blood supply. While principles of patient blood management (PBM) may have been previously implemented in many jurisdictions, their widespread adoption has become imperative during the pandemic. This review will discuss the impact of the COVID-19 pandemic on the Canadian blood supply and how the principles of PBM could be applied during a pandemic or other disruptions to healthcare delivery or blood supply. We described the local blood system and how it adapted during the pandemic. We also included a discussion of pandemic-associated local PBM challenges and solutions. We conducted a brief review of English language literature with a specific focus on the application of PBM to reduce unnecessary red blood cell (RBC) transfusions in elective major surgery, hematological malignancies, elective major gynecological surgery and obstetrics between January 2020 and April 2022. The common themes included anemia diagnosis and management, restrictive RBC transfusion strategies and reduction in blood loss. Anemia is common, is frequently caused by iron deficiency and can be treated with oral or intravenous iron. Erythropoiesis stimulating agents are effective in raising hemoglobin and may be indicated in certain perioperative settings. Evidence supports the use of restrictive RBC transfusion thresholds and single unit transfusions in most patient populations. Hemostatic therapy, such as tranexamic acid, is generally safe and effective in reducing bleeding. Diagnostic phlebotomy contributes to anemia and should be restricted to tests that are necessary and likely to change management. In conclusion, PBM interventions are generally effective and safe. Prioritization of PBM during the pandemic or a blood shortage may help sustain the blood supply and lead to improved patient outcomes.Copyright © Annals of Blood. All rights reserved.

Nutrition during the preschool years

The preschool years are a period of rapid growth and development, and children are at vulnerable to any amount and duration of nutritional shortfall. Globally, undernutrition remains a leading cause of death in this age group, with the prevalence of obesity rising in parallel. Young children need to be provided with a diet that is sufficiently nutrient dense and qualitatively diverse to meet their micronutrient needs but challenges with food shortage, access, and affordability often make this difficult. In this article, we present the current state of the evidence along with highlighting knowledge gaps on some of these topics. © 2023 Elsevier Ltd. All rights reserved

Iron and iron deficiency states: a modern view of the problem

The study of the mechanisms of regulation of iron metabolism, the physiological and pathological role of this trace element in the human body is relevant, scientifically and practically significant, especially against the backdrop of the COVID-19 pandemic. The available data on a decrease in the levels of hemoglobin and iron in the blood serum of patients with coronavirus infection suggest that this infection is associated with the formation of iron deficiency. Numerous studies have shown a negative effect of iron overload and an increased risk of replication of intracellular pathogens as a result of unjustified exogenous iron supplementation. That is why the issue of timely diagnosis and effective correction of iron deficiency and iron deficiency anemia (IDA) is extremely relevant outside of SARS-CoV-2 infection. Latent iron deficiency and IDA are pathological conditions that are constantly identified in clinical practice. These conditions are most common among children, women and the elderly in developing countries. These patient populations require effective repair of iron deficiency and monitoring of iron overload. Effective and safe iron supplements and supplements should be used to prevent / treat anemia. The dietary supplement Richter FerroBio manufactured by Gedeon Richter (Hungary) fully meets these criteria. © 2021, Publishing House Professional-Event. All rights reserved.

Top 20 Research Studies of 2021 for Primary Care Physicians

This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men;rectal bleeding in women;and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.Copyright © 2022 American Academy of Family Physicians.

Features of management of anemia in pregnant women who have recovered from COVID-19

The article provides the definition of iron deficiency anemia (IDA), discusses the mechanisms of influence of iron deficiency during pregnancy, as well as the main reasons for the development of IDA in the practice of an obstetrician-gynecologist, accompanied by a significant increase in the physiological need for iron. Methods for the correction and prevention of iron deficiency are described, and differences in the absorption of heme and non-heme iron are indicated. Also, this article reveals the advantages of prevention and dietary correction of iron deficiency states using a combination of heme iron and ferrous sulfate-Richter FerroBio. © 2021, Publishing House Professional-Event. All rights reserved.

Was Covid Era a Blessing in Disguise for the Patient?

Background and Aims: In the Covid era, Continuous blood glucose monitoring(CGM) was used more frequently and it proved to be quite a helpful and accurate tool for glycemic regulation. Method(s): 75 yrs old Saudi gentleman, had Type 2 diabetes >30yrs, Hypertension, Primary Hypothyroidism, dyslipidemia, mixed polyneuropathy, Iron deficiency anemia, and benign prostatic hypertrophy. In March,2020 his BP and blood glucose readings were high at home. He had a past history of subdural hematoma with hydrocephalus(staus post-shunting). He was on Glargine, oral hypoglycemic agents, anti-hypertensives, Levothyroxine, Atorvastatin, Aspirin, iron fumarate, calcium carbonate and cholecalciferol. Fully conscious, and co-operative, of average built and height.BP 170/70 mmHg, pulse 93/m, RR 18/ m,O2sat 100%, afebrile, BMI 24.96 kg/m2. Fundoscopy normal. He had dry feet and impaired monofilament and vibration testing. Result(s): Hb% 13.1g/dl(12.6 before),MCV 93.8fl,S.Ferritin 10.5ug/l(30-400),Vit.B12 270 pmol/l(145-637),HbA1c 8%(6.4 in Feb.2020).The renal, liver and thyroid functions-intact. Albumin creatinine ratio 12.23mg/g(0-30). Nerve conduction study-mixed polyneuropathy. He continued to follow-up physically even during the Covid crisis due to the elevated SMBG and BP values. Gliclazide & antihypertensive doses were optimized and Glargine was started.On patient's follow-up in August, 2020, time in range had improved to 80%(33% in June,2020),average glucose was 147 mg/dl(200 before), glucose variability was 27.8%(28.9), hypoglycemia (54-79mg/dl) was 1%(0). On last follow-up on 27.06.2022 his HbA1c had climbed up to 8.3%(7.3 in September, 2021). He was compliant to the diabetes regime, but had stopped using the Libre sensor. Conclusion(s): The case signifies the advantage of a meticulous CGM usage during the Covid pandemic, that resulted in a reasonable glycemic control.

Intravenous iron in patients with heart failure and iron deficiency: an updated meta-analysis.

AIMS: For patients with heart failure (HF) and iron deficiency (ID), randomized trials suggest that intravenous (IV) iron reduces hospitalizations for heart failure (HHF), but uncertainty exists about the effects in subgroups and the impact on mortality. We conducted a meta-analysis of randomized trials investigating the effect of IV iron on clinical outcomes in patients with HF. METHODS AND RESULTS: We identified randomized trials published between 1 January 2000 and 5 November 2022 investigating the effect of IV iron versus standard care/placebo in patients with HF and ID in any clinical setting, regardless of HF phenotype. Trials of oral iron or not in English were not included. The main outcomes of interest were a composite of HHF and cardiovascular death (CVD), on HHF alone and on cardiovascular and all-cause mortality. Ten trials were identified with 3373 participants, of whom 1759 were assigned to IV iron. IV iron reduced the composite of recurrent HHF and CVD (rate ratio 0.75, 95% confidence interval [CI] 0.61-0.93; p < 0.01) and first HHF or CVD (odds ratio [OR] 0.72, 95% CI 0.53-0.99; p = 0.04). Effects on cardiovascular (OR 0.86, 95% CI 0.70-1.05; p = 0.14) and all-cause mortality (OR 0.93, 95% CI 0.78-1.12; p = 0.47) were inconclusive. Results were similar in analyses confined to the first year of follow-up, which was less disrupted by the COVID-19 pandemic. Subgroup analyses found little evidence of heterogeneity for the effect on the primary endpoint, although patients with transferrin saturation <20% (OR 0.67, 95% CI 0.49-0.92) may have benefited more than those with values ≥20% (OR 0.99, 95% CI 0.74-1.30) (heterogeneity p = 0.07). CONCLUSION: In patients with HF and ID, this meta-analysis suggests that IV iron reduces the risk of HHF but whether this is associated with a reduction in cardiovascular or all-cause mortality remains inconclusive.

Rapid disease progression after enzyme replacement therapy interruption in a patient with cholesteryl ester storage disorder

Lysosomal acid lipase deficiency (LALD) has two clinical phenotypes: an infantile-onset form - Wolman disease (WD) presented by severe malabsorption, cholestasis, malnutrition, hepatosplenomegaly and early death, and a later-onset form - cholesteryl ester storage disorder (CESD) with hepatosplenomegaly, dyslipidemia, malabsorption and variable disease severity manifestation. Enzyme replacement therapy (ERT) with sebelipase alfa was approved by the Brazilian Health Regulatory Agency (ANVISA) in 2017. We report the deleterious effect of ERT interruption in a CESD patient. Male, 16y, diagnosed at 7y, positive familiar history with mother, grandfather and three siblings affected. He was enrolled in the phase 3 clinical trial from age 9-12y under the 3 mg/Kg dose regimen. Then he enrolled in the post-study donation program under the same dose. Due to personal, importation and supply issues, and the COVID-19 pandemic restrictions, he had a progressive decrease in treatment adherence rate: 68% at 12y, 27% at 13y, 30% at 14y and after that he had an interruption of 1 entire year. At 15y he presented with generalized edema, severe fatigue, tachycardia, was hospitalized, diagnosed low serum iron, albumin and protein, acute anemia (hemoglobin: 6.2 g/dL - normal range of 12,5-13,5), and received blood transfusion. In the next year, still without ERT, he was hospitalized again due to generalized edema, acute anemia (Hemoglobin = 6.9 g/dL) and worsening of hypoalbuminemia and iron deficiency, and received blood transfusion. Although our patient has the CESD phenotype, the ERT interruptions did not worsen the liver involvement nor the dyslipidemia, but caused a severe malabsorption which is classically described in WD phenotype. In conclusion, this case serves as an alert that when ERT is interrupted, there is a rapid clinical deterioration. Acknowledgements: to IGEIM, and Drs Felippe Raphael e Oliveira Previdi and Ana Eduarda Saraiva Pereira Campos for clinical assistance of the patient.

Ferric carboxymaltose and SARS-CoV-2 vaccination-induced immunogenicity in kidney transplant recipients with iron deficiency: The COVAC-EFFECT randomized controlled trial.

Background: Kidney transplant recipients (KTRs) have an impaired immune response after vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Iron deficiency (ID) may adversely affect immunity and vaccine efficacy. We aimed to investigate whether ferric carboxymaltose (FCM) treatment improves humoral and cellular responses after SARS-CoV-2 vaccination in iron-deficient KTRs. Methods: We randomly assigned 48 iron-deficient KTRs to intravenous FCM (1-4 doses of 500mg with six-week intervals) or placebo. Co-primary endpoints were SARS-CoV-2-specific anti-Receptor Binding Domain (RBD) Immunoglobulin G (IgG) titers and T-lymphocyte reactivity against SARS-CoV-2 at four weeks after the second vaccination with mRNA-1273 or mRNA-BNT162b2. Results: At four weeks after the second vaccination, patients receiving FCM had higher plasma ferritin and transferrin saturation (P<0.001 vs. placebo) and iron (P=0.02). However, SARS-CoV-2-specific anti-RBD IgG titers (FCM: 66.51 [12.02-517.59] BAU/mL; placebo: 115.97 [68.86-974.67] BAU/mL, P=0.07) and SARS-CoV-2-specific T-lymphocyte activation (FCM: 93.3 [0.85-342.5] IFN-É£ spots per 106 peripheral blood mononuclear cells (PBMCs), placebo: 138.3 [0.0-391.7] IFN-É£ spots per 106 PBMCs, P=0.83) were not significantly different among both arms. After the third vaccination, SARS-CoV-2-specific anti-RBD IgG titers remained similar between treatment groups (P=0.99). Conclusions: Intravenous iron supplementation efficiently restored iron status but did not improve the humoral or cellular immune response against SARS-CoV-2 after three vaccinations.

Iron: Not Just a Passive Bystander in AITD.

Autoimmune thyroid disease (AITD) is the most prevalent autoimmune disease all over the world and the most frequent cause of hypothyroidism in areas of iodine sufficiency. The pathogenesis of AITD is multifactorial and depends on complex interactions between genetic and environmental factors, with epigenetics being the crucial link. Iron deficiency (ID) can reduce the activities of thyroid peroxidase and 5'-deiodinase, inhibit binding of triiodothyronine to its nuclear receptor, and cause slower utilization of T3 from the serum pool. Moreover, ID can disturb the functioning of the immune system, increasing the risk of autoimmune disorders. ID can be responsible for residual symptoms that may persist in patients with AITD, even if their thyrometabolic status has been controlled. The human lifestyle in the 21st century is inevitably associated with exposure to chemical compounds, pathogens, and stress, which implies an increased risk of autoimmune disorders and thyroid dysfunction. To summarize, in our paper we discuss how iron deficiency can impair the functions of the immune system, cause epigenetic changes in human DNA, and potentiate tissue damage by chemicals acting as thyroid disruptors.

Psychological, Medical and Laboratory Predictors of Cardiac Anxiety in Patients with Heart Failure During the COVID-19 Pandemic

Objective: The aim of the study was to identify predictors of heart-focused anxiety in patients with heart failure. A better understanding of such predictors may help in detecting the comorbidity underlying heart-focused anxiety and identifying patients who need psychological help. Methods: In order to account for multiple sources of heart-focused anxiety, we included psychological, lifestyle, and medical/laboratory predictors. The study involved 148 patients, of whom 74 had a leading diagnosis of worsening heart failure and were hospitalized during the COVID-19 epidemic. A second group of 74 patients suffering from cardiovascular diseases without a diagnosis of acute heart failure, were examined in various out-patient cardiology clinics. The sample consisted of 37.8% females and 62.2% males, with an average age of 63.35 years. The patients completed the Cardiac Anxiety Questionnaire, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire, and the Intolerance of Uncertainty Scale. Results: Patients with heart failure with higher levels of depression and intolerance of uncertainty had higher overall levels of heart-focused anxiety, higher levels of fear about chest and heart sensations. Older patients with higher levels of depression had higher levels of activity avoidance, especially activities believed to elicit cardiac symptoms. Cardiac patients with higher level of anxiety and with anaemia as comorbidity had higher levels of heart-focused attention and monitoring of cardiac activity. Conclusion: In patients with heart failure, the presence of heart-focused anxiety significantly reduces the quality of life, leads to avoidant behaviours, and is associated with anxiety and depressive symptoms. These patients are more likely to seek medical help and specialist services, but the need for psychological help is very rarely recognized.