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.

The Impact of Covid19 Pandemic on Transfusion Dependent -Thalassemia Management: Experience of a Single Pediatric Treatment Center

Background: Health care systems have been facing COVID19 pandemic around the world for almost two years. Transfusion dependent (TDT) beta-thalassemia patients represent a vulnerable group,totally dependent upon hospital-based services. Aim(s): Aim of the present study was to evaluate the impact of COVID19 pandemic on management of TDT patients in a single pediatric treatment center in Northern Greece. Method(s): Patient records were reviewed in order to assess changes in management before and during the 24-month pandemic in Greece (03/01/2018-29/02/2020 and 03/01/2020 -28/02/2022, respectively) in terms of transfusion volume and transfusion frequency, mean value of pretransfusional hemoglobin, as well as laboratory parameters reflecting iron overload (ferritin levels, liver and heart MRI). Result(s): The study included 28 patients, 19 male (67.8%) and 9 female (32.2%), with an age range of 8 to 21 years. Mean number of hospital visits for transfusion was 19.97 +/- 3,52/ year prior to the pandemic and 22.38 +/- 4.35/year during the pandemic (p: 0.003). Average transfusion volume was 176.18ml +/- 38.32/kg/year kappaalphai 178.67 +/- 37.64ml/kg/year, respectively (p: 0.54). With regards to hemoglobin level, mean value was 9.56 +/- 0.42g/dl prior to the pandemic and 9.45 +/- 0.48gr/dl during the pandemic period. As to iron overload, mean ferritin level was 1362.05 +/- 517.56 ng/mL prior to the pandemic and 1021.27 +/- 508.92 ng/mL during the latter time period (p:0.016). Out of 28 enrolled patients, 26 underwent heart and liver MRI before pandemic and 23 during the pandemic period. Mean LIC values were 6.84 +/- 7.37 mg/gdw and 6.43 +/- 6.46 mg/gdw (p: 0.97) before and during the pandemic, respectively (p:0.97). Myocardial MRI values were within normal limits both before and during the pandemic. Summary-Conclusion: Covid19 pandemic did not seem to negatively affect the primary goal of transfusion therapy (pretransfusion Hb), even if an increased number of visits was required in order to transfuse the same blood volume - due to limited availability of blood units per visit. Of interest, pandemic conditions appeared to favor patient adherence to chelation therapy.

Application of hybrid advanced oxidation and adsorption processes for pharmaceutical wastewater treatment

During a coronavirus pandemic, the use of drugs that subsequently enter and contaminate water resources increases significantly. Water contaminated with pharmaceutical substances becomes dangerous to human health and threatens the functioning of all ecosystems. The use of various methods of wastewater treatment and solving this problem are still ongoing, so this chapter is devoted to one of the improved method that provides a synergistic effect of removing drugs from wastewaters. Advanced oxidation processes are popular for water purification, but their use is expensive, accompanied by the consumption of large amounts of electricity, and requires expensive materials. The combination of such methods with adsorption can reduce operating costs and increase process productivity, so the use of a hybrid oxidation process and adsorption is an excellent alternative for water purification from pharmaceuticals. The book chapter describes the main advantages and disadvantages of advanced oxidation processes (photocatalysis, ozonation, electrochemical oxidation, and Fenton processes). The adsorption process and effective materials used as adsorbents are described. The most common combinations of oxidation and adsorption processes, that generate active radicals, interact with a potential contaminant adsorbed on the adsorbent surface and decompose them to CO2 and H2O, are demonstrated. Hybrid methods of photocatalysis, Fenton process, ozonation and adsorption are presented, their mechanism and advantages over conventional methods in water purification from pharmaceutical compounds are described. The application of photocatalysis and adsorption is covered in details, and materials with photocatalytic properties and high surface area (iron oxides, titanium(IV) oxide, and zinc oxide) are characterized. As a result, the hybrid methods are considered effective for wastewater treatment from pharmaceutical contaminants. © 2023 Elsevier Inc. All rights reserved.

Characterization of varieties biofortified in iron and zinc and local varieties of common bean

Iron and zinc are important minerals in humans in sub Saharan Africa, whose deficiency is known as "hidden hunger" due to the lack of recognised symptoms in the early stages. Although iron deficiency is the most prevalent, zinc is also involved in inhibition of replication of viruses, including the corona virus (COVID-19). In North Kivu and South Kivu provinces where more than 50% of common bean is produced and consumed in Democratic Republic of Congo, 36% and 47% of preschool children are anemic due to iron deficiency. This paradox is mainly due to insufficiency of iron-rich foods. The aim of this study is to characterise 59 iron and zinc biofortified varieties together with six local varieties of common bean for a potential selection programme in Butembo town in the Democratic Republic of Congo. We focused on 15 qualitative and five quantitative parameters. The qualitative parameters were helpful to distinguish the different morphotypes and for cluster analysis. In addition to the descriptive statistics, the quantitative data were used for Pearson correlation and for principal component analysis, PCA. Qualitative parameters enabled grouping of the study genotypes into 14 morphotypes according to the aspect and colour of the seed coat, the colour around the hilum and the size of seeds. Clustering grouped the 65 genotypes into 12 clusters with the most similar genotypes grouped in the same cluster. Quantitative parameters showed that the study genotypes were dissimilar (P=0.00). A positive correlation was obtained between the days to flowering and the days to maturity (P<0.05) and between the number of pods per plant and the days to flowering. A strong correlation was found between the number of pods per plant and seeds per pod (P<0.01). In contrast, a negative correlation was observed between the 100 seed weight and the number of seeds per pod. The PCA represented on two perpendicular axes showed 64.1% of the total variance of which the 42.3% is explained by the first axis and 21.8% by the second axis. Overall, the study genotypes are morphologically and quantitatively different and thus can be used in a selection programme.

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.

Risk of infection with ferric derisomaltose compared to standard of care in patients with heart failure and iron deficiency in the uk: a prespecified analysis of the ironman trial

IntroductionRecent results from the IRONMAN trial add to previous data and demonstrate that correction of iron deficiency in patients with heart failure, with high dose IV iron can improve quality of life, and reduce the risk of heart failure hospitalisation (by around 25% in meta-analysis). Yet there are theoretical risks that IV iron administration may increase the risk from bacterial infection. A meta-analysis in 2021 (across many clinical indications) suggested an excess risk of infections with IV iron but noted most trials did not pre-specify infection as an end point, with risk of reporting bias. To answer this important question hospitalisation for infection or death due to infection were pre-specified safety endpoints in IRONMAN.MethodsIRONMAN was a prospective, randomised open-label, blinded endpoint (PROBE) event-driven trial of IV ferric derisomaltose (FDI) and usual care versus usual care alone in patients with heart failure (LVEF ≤45% ) and iron deficiency (ferritin <100 µg/L and/or TSAT <20%, provided ferritin ≤400 µg/L). Patients were enrolled if they had a current or recent hospitalisation for heart failure or elevated natriuretic peptide plasma concentration. Every four months, IV iron was administered if either ferritin was <100 µg/L or TSAT was <25% (provided ferritin ≤400 µg/L). All hospitalisations and deaths were adjudicated blindly. Given that a large part of the trial was conducted during the COVID-19 pandemic, we also evaluated COVID-19 related SAEs.Results1137 patients (26.4% women) with median (IQR) age 73 (63 to 79) years were recruited by the Ironman Study Group between Aug 2016 and Oct 2021 across 70 UK sites. Median (IQR) follow-up was 2·7 (1·8 to 3·6) years. 97% of patients consented to record linkage to national databases of deaths and hospital discharge summaries, thereby ensuring investigators were aware of all potential events. There were a similar number of hospitalisations due to infection for those assigned to ferric derisomaltose (175) and usual care (213) (p = 0.16) and infection related death (34 and 28, respectively, p = 0.43). When considering first events of hospitalisation for infection or infection death there were 120 (21.1%) events for those randomised to IV FDI and 146 (25.7%) for the usual care arm (figure). There were fewer patients with COVID related SAEs in those randomised to IV FDI (12) as compared with usual care (30), HR (95% CI) 0.40 (0.20, 0.78). p=0.007. For deaths attributed to COVID-19, 4 were seen in the IV FDI arm and 8 in the usual care arm: HR 0.51 (0.15, 1.68) p=0.27.ConclusionsThere was no excess risk of infection related hospitalisation or death in patients receiving IV ferric derisomaltose. Fewer COVID-19 related SAEs were seen in patients receiving IV FDI. Given that iron plays an important role in the T and B cell response to vaccination, further analysis needs to be done in this area.Conflict of InterestHonorarium for education from Pharmocosmos

The COVID-19 and iron-repertoire in an observational cross-sectional analytical study of Egyptian patients

Background and rationale: Coronavirus disease 2019 (COVID-19) infection is a respiratory tract infection because of a novel coronavirus. The clinical picture ranges from asymptomatic to severe manifestations mandating intensive care and respiratory support. We aimed to assess the serum level of iron, total iron binding capacity (TIBC), and transferrin saturation in COVID-19 patients and their relation to disease severity and outcome. Methodology: This observational cross-sectional analytical study was conducted on 100 confirmed cases of COVID-19 who were admitted to Kasr Al-Ainy hospitals between June and December 2020.Serum levels of iron, total iron binding capacity (TIBC), and transferrin saturation were measured for all study populations. Result: One hundred patients were involved in this research, 51males and 49 females, with a mean age of 51±14.9years. Regarding the disease severity,53% were moderate cases, 34% were mild, and 13% were severe cases. Fifty-two (54.2%) patients showed normal serum levels of iron, 38 patients (39.6%) showed high serum levels of iron, and 6 patients (6.3%) showed low serum levels of iron. The mean ±SD values of iron, TIBC, and transferrin saturation were 163.1±105 mcg/dL, 366 ± 162.6 mcg/dL, 44.4 ± 20.2 %, respectively. Iron, total iron binding capacity (TIBC) levels and transferrin saturation did not show a significant association as regards either COVID-19 severity or mortality. Mortality and deterioration were detected in 31.7% out of 60 patients with COVID-19. The results showed that obese patients showed a higher percentage of severe COVID-19,which was statistically significant (p=0.037).There was a statistically significant higher mortality rate in patients with severe COVID-19 (p=0.000).High mortality was observed significantly in patients with diabetes mellitus (p=0.041).Iron levels, total iron binding capacity (TIBC) levels and transferrin saturation did not show a significant association regarding either COVID-19 severity or mortality. Conclusion: In our study, COVID-19 severity was not related to iron metabolism but was affected by obesity and diabetes mellitus. COVID-19 mortality was significantly associated with diabetes. © 2020 The author (s). Published by Zagazig University.

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.

Deferoxamine has the Potential to Improve the COVID-19-Related Inflammatory Response in Diabetic Patients.

The clinical state of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been considered a pandemic disease (COVID-19) that is rapidly spreading worldwide. Despite all global efforts, the only treatment for COVID-19 is supportive care and there has been no efficient treatment to fight this plague. It is confirmed that patients with chronic diseases such as cardiovascular disorder and diabetes; are more vulnerable to COVID-19. In the severe type of COVID-19, laboratory findings showed a remarkably enhanced C-reactive protein, IL-6 serum, Iron, and ferritin, which suggest an inflammatory response. Inflammation results in iron homeostasis imbalance and causes iron overload, exacerbating the SARSCOV2 infection. More importantly, recent studies have established that SARS-CoV-2 needs iron for viral replication and also activation. As a result, managing iron overload in diabetic patients with COVID-19 could be an early therapeutic approach to limit the lethal inflammatory response of COVID-19. In this review, Deferoxamine (DFO) has been proposed as an effective iron chelator agent.

A novel view of ferritin in cancer.

Since its discovery more than 85 years ago, ferritin has principally been known as an iron storage protein. However, new roles, beyond iron storage, are being uncovered. Novel processes involving ferritin such as ferritinophagy and ferroptosis and as a cellular iron delivery protein not only expand our thinking on the range of contributions of this protein but present an opportunity to target these pathways in cancers. The key question we focus on within this review is whether ferritin modulation represents a useful approach for treating cancers. We discussed novel functions and processes of this protein in cancers. We are not limiting this review to cell intrinsic modulation of ferritin in cancers, but also focus on its utility in the trojan horse approach in cancer therapeutics. The novel functions of ferritin as discussed herein realize the multiple roles of ferritin in cell biology that can be probed for therapeutic opportunities and further research.

COVID-19 compromises iron homeostasis: Transferrin as a target of investigation.

IMPORTANCE: Since the beginning of the COVID-19 pandemic, numerous metabolic alterations have been observed in individuals with this disease. It is known that SARS-CoV-2 can mimic the action of hepcidin, altering intracellular iron metabolism, but gaps remain in the understanding of possible outcomes in other pathways involved in the iron cycle. OBJECTIVE: To profile iron, ferritin and hepcidin levels and transferrin receptor gene expression in patients diagnosed with COVID-19 between June 2020 and September 2020. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study that evaluated iron metabolism markers in 427 participants, 218 with COVID-19 and 209 without the disease. EXPOSURES: The primary exposure was positive diagnose to COVID-19 in general population of Santo André and São Bernardo cities. The positive and negative diagnose were determinate through RT-qPCR. MAIN OUTCOMES AND MEASURES: Devido a evidências de alterações do ciclo do ferro em pacientes diagnosticados com COVID-19 e devido a corregulação entre hepcidina e receptor de transferrina, uma análise da expressão gênica deste último, poderia trazer insights sobre o estado de ferro celular. A hipótese foi confirmada, mostrando aumento da expressão de receptor de transferrina concomitante com redução do nível de hepcidina circulante. RESULTS: Serum iron presented lower values in individuals diagnosed with COVID-19, whereas serum ferritin presented much higher values in infected patients. Elderly subjects had lower serum iron levels and higher ferritin levels, and men with COVID-19 had higher ferritin values than women. Serum hepcidin was lower in the COVID-19 patient group and transferrin receptor gene expression was higher in the infected patient group compared to controls. CONCLUSIONS AND RELEVANCE: COVID-19 causes changes in several iron cycle pathways, with iron and ferritin levels being markers that reflect the state and evolution of infection, as well as the prognosis of the disease. The increased expression of the transferrin receptor gene suggests increased iron internalization and the mimicry of hepcidin action by SARS-CoV-2, reduces iron export via ferroportin, which would explain the low circulating levels of iron by intracellular trapping.

Ferroptosis and multi-organ complications in COVID-19: mechanisms and potential therapies.

COVID-19 is an infectious disease caused by SARS-CoV-2, with respiratory symptoms as primary manifestations. It can progress to severe illness, leading to respiratory failure and multiple organ dysfunction. Recovered patients may experience persistent neurological, respiratory, or cardiovascular symptoms. Mitigating the multi-organ complications of COVID-19 has been highlighted as a crucial part of fighting the epidemic. Ferroptosis is a type of cell death linked to altered iron metabolism, glutathione depletion, glutathione peroxidase 4 (GPX4) inactivation, and increased oxidative stress. Cell death can prevent virus replication, but uncontrolled cell death can also harm the body. COVID-19 patients with multi-organ complications often exhibit factors related to ferroptosis, suggesting a possible connection. Ferroptosis inhibitors can resist SARS-CoV-2 infection from damaging vital organs and potentially reduce COVID-19 complications. In this paper, we outline the molecular mechanisms of ferroptosis and, based on this, discuss multi-organ complications in COVID-19, then explore the potential of ferroptosis inhibitors as a supplementary intervention for COVID-19. This paper will provide a reference for the possible treatment of SARS-CoV-2 infected disease to reduce the severity of COVID-19 and its subsequent impact.

A comparative study of serum Zn, Cu, Mg, Mn, Cr, and Fe levels and their association with the vulnerability of Iraqi COVID-19 patients.

BACKGROUND: For the immune system to protect the body from infectious diseases such as COVID-19, it needs the ideal amount of vital trace elements. Trace element levels, especially, zinc (Zn), copper (Cu), magnesium (Mg), manganese (Mn), chromium (Cr), and iron (Fe) levels, may affect how sensitive an individual is to COVID-19 and other viruses. The current study evaluated the level of those trace elements during stays in the isolation center and investigated their association with vulnerability to COVID-19. METHODS: A total of 120 individuals, 49 males and 71 females aged between 20 and 60 years, were included in this study. Forty individuals infected with COVID-19, 40 individuals who had recovered from it, and 40 healthy individuals, were all evaluated and studied. By using a flame atomic absorption spectrophotometer, levels of Zn, Cu, and Mg were assessed for all samples, whereas levels of Mn, and Cr were determined by a flameless atomic absorption spectrophotometer. RESULTS: The infected individuals had significantly lower levels of Zn, Mg, Mn, Cr, and Fe than recovered individuals and healthy control individuals (P < 0.0001). On the other hand, the total number of infected patients was found to have much higher levels of Cu than those in the recovered group and the control group. For the recovered and healthy control groups, no significant differences were observed in the levels of trace elements (P > 0.05), except for Zn (P < 0.01). Also, the findings indicated no association of trace elements with age and BMI (P > 0.05). CONCLUSION: These results show that an imbalance in the levels of essential trace elements could be associated with increasing the risk of COVID-19 infection. However, additional thorough research of greater scope is required considering the severity of the infection.

Spirulina platensis from Nomayos: a potential health food for the management of COVID-19 infection

The proteins (37%), carbohydrates (24.4%) and lipids (30.1%) contents of S. platensis from Nomayos provide the body with its structural and energy needs for about 518.8 Kcal per 100g of spirulina. Polyphenols (56.4 mEq. QE / g ES.), flavanols (13.2 mEq. QE / g ES.) flavonoids (21.2 mEq. QE / g ES.), carotenoids (3, 8%) and phycocyanin (16.15%) is responsible of its antioxidant capacities (7.5 + 0.33 mg eq. Vit C/g ES) and for a significant decrease in malondialdehyde MDA (< 0.001) concentration. Zinc (25 mG/Kg), Iron (256 mG/Kg), Selenium (1.24 mG/Kg), Manganese (23mG/Kg) and Copper (28.95 mG/Kg) reinforce this antioxidant power because they are cofactors of enzymes (Superoxide dismutase, Peroxidase, Catalase) which ensure the fight against free radicals. The presence of phycocyanin is an asset for the anti-inflammatory action. The significant decrease in IL-8 (p < 0.001) and TNF alpha (p < 0.04) levels confirms this property. On the other hand, the nonsignificant increase in Il-6 (1.56 to 2.18 pg/m;p > 0.05) would be partly responsible for the rise in CD4 levels (p < 0.001) and the reduction in viral load in immune deficiency patients (p = 0.000) supplemented with spirulina. In conclusion, S. platensis from Nomayos by its antioxidant, anti-inflammatory and immuno-stimulatory properties would be a good supplement food for subjects at risk of developing severe forms of COVID-19.

Hepatotoxicity From Marijuana Gummies

Introduction: We report a case of drug-induced liver injury (DILI) induced by cannabis gummies containing Corydalis Rhizome. Case Description/Methods: A 37-year-old female presented to her primary care clinic with recurrent fevers, night sweats, and myalgias for 7 weeks accompanied by eye redness, brain fog, headache, nausea, and abdominal pain. She denied rashes, tick-bites, cough, dyspnea, chest pain, joint swelling, or genitourinary symptoms. Past medical history was notable for IBS, migraines, and anxiety. She reported edible marijuana use four times a week, rare alcohol use, and denied tobacco use. She denied a family history of liver disease. Physical exam was notable for tachycardia to 110 and scleral injection with the remainder of vitals and exam unremarkable. Initial labs were notable for AST 61, ALT 44 and CRP of 12. CBC, BMP, urinalysis, ESR, blood cultures, blood smear for parasite screen, tests for Lyme disease, Babesia, Tularemia, Anaplasma, Ehrlichia, Rickettsia, EBV, HIV, RPR, ANA, CMV, parvovirus B19, and chest x-ray were all negative. The patient was referred to infectious disease with further testing for West Nile, Leptospira, lymphocytic choriomeningitis virus, and COVID-19 returning negative. Repeat LFTs showed worsening transaminitis with ALT 979 and AST 712, alkaline phosphatase 88, total bilirubin 0.7, and albumin 4.9. Hepatitis workup including hepatitis A, B, and C, HSV, EBV, VZV serologies, AMA, ASMA, antiLKM Ab, acetaminophen level, INR, iron panel, CPK, TSH, and abdominal ultrasound were all normal. It was later discovered that her marijuana gummies contained Corydalis rhizome extract known to be hepatotoxic. Cessation of this drug was strongly advised. She was discharged with hepatology follow-up and underwent a liver biopsy showing patchy periportal and lobular inflammation with extension across the limiting plate, hepatocyte injury and apoptosis, and increased lipofuscin for age compatible with mild to moderate hepatitis. She had complete recovery after cessation of Corydalis-containing gummies. (Figure) Discussion: Our patient consumed '1906 Midnight', an American cannabis brand containing Corydalis rhizopus 100 mg, advertised to improve sleep, pain, and have a liver protective effect. A Korean systematic review on herbal-induced liver injury reported that Corydalis was the 3rd most frequent causative herb, with 36 cases. Although there are several personal accounts on social networking sites and other websites, there are no American-based publications reported on DILI from Corydalis. (Table Presented).

Ferroptosis Is a Potential Therapeutic Target for Pulmonary Infectious Diseases

Ferroptosis is a new type of iron-dependent cell death caused by lipid peroxide (LPO) accumulation and involved in disease of pulmonary infection. The dysregulation of iron metabolism, the accumulation of LPO, and the inactivation and consumption of glutathione peroxidase 4 (GPX4) are the crucial cause of ferroptosis. Pulmonary infectious diseases caused by Pseudomonas aeruginosa (PA), Mycobacterium tuberculosis (MTB), and severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are associated with ferroptosis. Ferroptosis may be a potential therapeutic target for pulmonary infectious diseases. However, the mechanisms by which these infections are involved in ferroptosis and whether pulmonary infectious diseases caused by Staphylococcus aureus, Klebsiella pneumoniae, and Leishmania spp are related to ferroptosis are unclear. Accordingly, more researches are needed.Copyright © 2023 Yurong Zhang et al.

Can AIS data improve the short-term forecast of weekly dry bulk cargo port throughput? - a machine-learning approach

This study examines the development of a machine-learning model to forecast weekly throughputs of dry bulk cargo in the short term based on automatic identification system (AIS) data. Specifically, the weekly amounts of iron ore exported from several major ports in Australia and Brazil in the latter half of 2019 are forecasted three weeks in advance using a long short-term memory model. We examine many variables extracted from AIS data, including the vessel position, speed, draught, and destination, as the input features of the model. Consequently, we develop a highly accurate forecasting model that uses four influential variables derived from AIS data, namely, vessel traffic around the target port and in the region, vessel traffic at major partner import ports, and vessel traffic at the target port during the past year. Finally, by forecasting the weekly port cargo throughputs in the first half of 2020, which was affected by the COVID-19 pandemic, the applicability of the model is confirmed, even for ports where the throughput fluctuates significantly. In particular, this study demonstrates that AIS data are beneficial not only as a real-time traffic database but also as a database containing various related explanatory variables, including historical vessel traffic. [ FROM AUTHOR] Copyright of Maritime Policy & Management is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The relation of hepcidin, vitamin D and inflammatory parameters, and effects on intensive care unit outcome in critically ill COVID-19 patients

Objectives: Aim of this study was to evaluate hepcidin levels and its correlation with inflammatory markers, vitamin D levels as well as its effects on intensive care unit (ICU) mortality in critically ill coronavirus disease-2019 (COVID-19) patients. Materials and Methods: Adult patients those were admitted to pandemic ICU between March 1st, 2021 and May 17th 2021 were prospectively included to the study. Hepcidin levels and inflammatory markers on day 1, 2, 3 and 7, admission vitamin D levels, length of ICU stay and ICU mortality were recorded and analysed. Results: Median age of patients was 60.5 (52.50-71.25) and 20 (66.7%) of them was male. It was observed that hepcidin levels and lymphocyte counts were increased significantly from day 1 to day 7 (p=0.01 and p<0.01, respectively). In contrast, C-reactive protein (CRP) and procalsitonin levels were decreased from day 1 to day 7 (p=0.01 and p<0.01, respectively). In the analysis admission hepcidin levels and inflammatory markers [IL-6 (p=0.61), CRP (p=0.82) and ferritin (p=0.27)], vitamin D (p=0.13) and iron level (p=0.90) was not correlated. There was no correlation between hepcidin levels and ICU mortality (p=0.95). Conclusion: In this study, hepcidin levels were above normal limits in critically ill COVID-19 patients. However, our findings do not support the use of hepcidin, IL6, serum ferritin, and vitamin D levels in predicting COVID-19 mortality.