BACKGROUND: A defective synthesis of vitamin D contributes to alterations in calcium homeostasis due to chronic endocrinopathies, leading to metabolic bone diseases. This study aimed to ascertain the levels of calcium, vitamin D, and parathyroid hormone (PTH) in children with β-thalassemia.
METHODS: In this case-control study, 36 children with major β-thalassemia receiving iron chelation therapy were included. For the control group, 36 cases matched for age and sex were selected. The packed cell volume (PCV) requirements varied among the thalassemic children, with an average PCV requirement of 78.57±49.07. The study was conducted for six months in the Department of Pediatrics at the Government Medical College, Nagpur, India. Serum PTH levels were determined by immunoassay, and serum vitamin D levels were assessed using electrochemiluminescence technique. Additional tests looked at liver function, serum ferritin, calcium, phosphorus, and complete blood count. The student\'s t-test, Mann-Whitney, and chi-square tests were used for statistical analysis.
RESULTS: In comparison to the control group (10.4±1.21 g/dL), the case group\'s mean hemoglobin level was considerably lower (5.62±1.9 g/dL) (p<0.001). The mean serum ferritin level in the cases was notably higher (3073±1262.24 ng/mL) compared to the control group\'s level (58.37±29.67 ng/mL) (p<0.001). A total of 80.6% of cases compared to 5.6% of controls had vitamin D deficiency, and 72.2% of cases compared to 2.8% of controls had PTH deficit, both of which showed statistically significant differences (p<0.001). Significant differences were observed between the case and control groups for the mean levels of total serum calcium (8.51±0.84 mg/dL), vitamin D (15.23±10.07 ng/mL), and PTH (14.66±19.86 pg/mL) (9.13±0.6 mg/dL, p=0.05; 34.94±9.57 ng/mL, p<0.001; 32.08±12.42 pg/mL, p<0.001; respectively).
CONCLUSIONS: Growth failure may result from the markedly reduced serum calcium, vitamin D, and PTH levels in children with β-thalassemia. The relevance of treatment approaches is highlighted by the possibility that these anomalies are caused by excessive iron and inadequate nutritional support.

The dynamically evolving science of pharmacology requires AI technology to advance a new path for drug development. The author proposes generative AI for future drugs, identifying suitable drug molecules, uncharacteristically to previous generations of medicines, incorporating the wisdom, experience, and intuit of traditional materia medica and the respective traditional medicine practitioners. This paper describes the guiding principles of the new drug development, springing from the tradition and practice of Tibetan medicine, defined as the Interactive Nutrient Process (INP). The INP provides traditional knowledge and practitioner\'s experience, contextualizing and teaching the new drug therapy. An illustrative example of the outcome of the INP is a potential small molecule drug, 6-Shogaol and related shogaol derivatives, from ginger roots (Zingiber officinalis fam. Zingiberaceae) evaluated clinically for 12 months for biological markers of iron homeostasis in patients with the myelodysplastic syndromes (MDS). The study\'s preliminary results indicate that 6-Shogaol and related shogaols may improve iron homeostasis in low-risk/intermediate-1 MDS patients without objective or subjective side effects.

UNASSIGNED: The presence of extensive dental caries leads to pain, inflammation, and discomfort and hence interferes with their nutritional intake, which includes iron deficiency anemia. This study was undertaken to determine whether any correlation exists between severe early childhood caries (S-ECC), serum iron, and serum ferritin levels in children.
UNASSIGNED: A total of 688 children were examined in the age-group of 2-6 years, and 82 children who fulfilled the selection criteria were equally divided into group I, that is, case group (carious group n = 41) and group II, that is, control group (caries-free group n = 41), on the basis of decayed, missing, and filled primary teeth (dmft) scores. All the selected children in both groups underwent blood investigations through phlebotomy for assessment of serum iron and serum ferritin levels.
UNASSIGNED: The mean values of variables, that is, hemoglobin (Hb), serum iron, serum ferritin, total iron-binding capacity (TIBC), and unsaturated iron-binding capacity (UIBC), are lower in the case group when compared to control group. The differences observed were statistically significant in case of dmft and UIBC values at p < 0.05 but not significant in cases of other variables like Hb, serum iron, serum ferritin, and TIBC values.
UNASSIGNED: An inverse relationship was found between S-ECC, serum iron, and serum ferritin levels, but the evidence is still inconclusive.
UNASSIGNED: Atri Y, Garg N, Pathivada L, et al. Association between Serum Iron, Serum Ferritin Levels, and Severe Early Childhood Caries: A Case-Control Study. Int J Clin Pediatr Dent 2023;16(S-3):S288-S292.

Iron deficiency is a common problem in subfertile women. The influence of iron status on unexplained infertility is unknown.
In a case-control study, 36 women with unexplained infertility and 36 healthy non-infertile controls were included. Parameters of iron status including serum ferritin and a serum ferritin <30 µg/dL served as main outcome parameters.
Women with unexplained infertility demonstrated a lower transferrin saturation (median 17.3%, IQR 12.7-25.2 versus 23.9%, IQR 15.4-31.6; p= 0.034) and a lower mean corpuscular hemoglobin concentration (median 33.6 g/dL, IQR 33.0-34.1 versus 34.1 g/dL, IQR 33.2-34.7; p= 0.012). Despite the fact that there was no statistically significant difference in median ferritin levels (p= 0.570), women with unexplained infertility had ferritin levels <30µg/L more often (33.3%) than controls (11.1%; p= 0.023). In a multivariate model, unexplained infertility and abnormal thyroid antibodies were associated with ferritin <30µg/L (OR 4.906, 95%CI: 1.181-20.388; p= 0.029 and OR 13.099; 2.382-72.044; p= 0.029, respectively).
Ferritin levels <30µg/L were associated with unexplained infertility and might be screened in the future. Further studies with a focus on iron deficiency and iron treatment on women with unexplained infertility are warranted.

India was severely affected by the second wave of coronavirus disease (COVID‑19), leading to sudden expansive spread of Mucormycosis, presenting with sinusitis, blackish mucus secretions, discolouration of palate, facial pain, swelling and blurring of vision. Hyperglycemia, hypercoagulable state and elevated levels of serum ferritin were the major contributing factors in progression of the deadly disease. To highlight the correlation between Diabetes Mellitus, hyperferritenimia and elevated levels of D-Dimer with increased rate of incidence and poor prognosis of the disease. This study was undertaken in KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, including 30 patients, between April to July 2021. Serum ferritin, HbA1C and D-Dimer were evaluated for patients on admission, along with the other routine blood investigations. The mean age was 50 years (49.99 ± 1.8), with a male predominance of 83.33% (25 Male patients). 93.33% patients had uncontrolled Diabetes Mellitus with a mean value of 10.12% (± 0.37) indicating Diabetes Mellitus to be the prime risk factor. The raised levels of serum ferritin with a mean of 662.01 ng/ml (± 129.18) and high levels of D-Dimer (Mean- 761.33 ± 151.8 ng/ml) also demonstrated their role as interlinked factors. Mucor epidemic was caused by convergence of interlinked risk factors. Awareness of red flag clinical features, prompt diagnosis, early initiation of treatment with amphotericin-B with aggressive surgical debridement are essential for successful outcome, to avoid high rate of mortality and morbidity rates in the mucormycosis patients.

OBJECTIVE: This study aimed to contrast and compare serum ferritin, hemoglobin, Vitamin D3, Ca++, thyrotropin-releasing hormone (TRH), and serum albumin levels between preschoolers with severe caries (SC) and measures taken for caries control.
METHODS: A sample size of 300 children was selected but only 266 participated; 54.14% with SC and 45.86% caries-free. Blood samples for serum ferritin, hemoglobin, Vitamin D3, Ca++, TRH, and serum albumin levels were taken.
RESULTS: The mean age was estimated to be 40.82 + 14.09 months. The serum ferritin level estimated mean value for sample pedodontic subjects came to be 29.58 ± 17.87 μg/L whereas their hemoglobin level with mean value 115.13 ± 10.12 g/L was measured. Logistic regression analysis (LRA) suggested that children with SC were nearly two times as likely to have ferritin level depreciation and likely six times more chance of FeDA (iron deficiency anemia) than in children with caries control. Children with SC had significantly lower mean Vitamin D3 value (p < 0.001), Ca++ (p < 0.001), and serum albumin (p < 0.001) levels, and significantly higher thyrotropin-releasing factor (p < 0.001) levels than those subjects without caries.
CONCLUSIONS: Analysis of children with SC at a very young age significantly showed an increased chance of low ferritin levels than children with a caries-free mouth. The level of hemoglobin was deficient in children with SC at a very young age. Children with SC at a very young age appeared to be malnourished when compared with children without dental caries. Other contrasting parameters like FeDA, Vitamin D3, Ca++, and serum albumin concentrations were significantly deficient in children with SC at a very young age, in contrast, to a sample of children with a caries-free mouth. The analysis also suggested an increased level of TRH.
CONCLUSIONS: The following research study sets a benchmark for the dental fraternity and other health specialists to analyze serum ferritin, hemoglobin, Vitamin D3, Ca++, TRH, and serum albumin levels while generally treating pediatric patients. Accordingly, supplements should be prescribed rationally even in dental caries.
UNASSIGNED: Jha A, Jha S, Shree R, et al. Association between Serum Ferritin, Hemoglobin, Vitamin D3, Serum Albumin, Calcium, Thyrotropin-releasing Hormone with Early Childhood Caries: A Case-Control Study. Int J Clin Pediatr Dent 2021;14(5):648-651.

Mucormycosis is a very morbid and potentially life threatening fungal infection. Sudden emergence and rapidly increasing numbers, of an otherwise rare infection in active Corona virus disease 2019 (COVID-19) or recently recovered patients has made us question the cause for this epidemic in India. This retrospective cohort study was done at Government Ear, Nose and Throat (ENT) hospital, Hyderabad, a designated nodal centre for mucormycosis for the state of Telangana, between April 2021 and June 2021. This study included patients with mucormycosis who had a recent history of COVID-19 infection. Potential predisposing factors (diabetes mellitus, history of oxygen and corticosteroids usage) and inflammatory marker values, predominantly deranged in COVID-19 infection (D-dimer and Serum Ferritin) were evaluated. A correlation between the marker values and susceptibility factors was also studied. Majority of these subjects showed elevated serum markers and had one or more of the predisposing factors for COVID-19 associated mucormycosis (CAM). A significant association was found between elevated marker values and susceptibility factors (diabetes, use of oxygen). Contrary to the popular belief, that the inadvertent use of steroids, use of industrial oxygen or elevated blood sugars caused this epidemic, our study concludes that their role is limited to affecting the extent of morbidity/mortality. B.1.1.7 and B.6.117 variants of severe acute respiratory syndrome coronavirus 2 (SARSCoV2), predominant during the second wave in India, facilitated the fungal invasion and spread by altering the gene expression and inducing inflammatory and immunomodulatory changes.

Secondary iron overload is increasingly encountered in chronic kidney disease (CKD) patients because of the frequent use of parenteral iron products, especially in hemodialysis patients. Serum ferritin has been commonly used to monitor iron overload in these patients; however, other conditions can be associated with the high serum ferritin, like infections and inflammatory conditions. Currently, T2*MRI of the heart and liver is the preferred investigation for evaluating liver iron concentration (LIC) and cardiac iron concentration, which reflect the state of iron overload. Few studies observe a positive correlation between serum iron and LIC in CKD patients and postulate that serum ferritin exceeding 290 mcg/L should indicate significant iron overload and necessitates further MRI evaluation. However, here, we present a patient with a history of ESRD for which she underwent renal transplantation twice referred to our clinic due to persistent elevation in serum ferritin level (>1000 mcg/L) for several years. T2*MRI of the heart and liver revealed the absence of iron overload. Our objective of this case is to demonstrate the accuracy of T2*MRI over serum ferritin in evaluating iron overload and questioning the positive correlation between serum ferritin and LIC in CKD patients.

OBJECTIVE: Previous studies suggest that serum ferritin may be associated with higher risk of liver cancer. However, additional studies of the association are needed. It is also not clear whether serum ferritin is associated with mortality from chronic liver disease (CLD).
METHODS: We performed a nested case-control study in the Linxian Nutrition Intervention Trials. Baseline serum ferritin was measured for 226 incident primary liver cancer cases, 281 CLD mortalities diagnosed, and 1061 age-matched, gender-matched, and trial-matched controls. We used multivariable logistic regression models to calculate odds ratios and 95% confidence intervals. Subgroup analysis and interaction tests were performed by age, gender, alcohol drinking, hepatitis B virus seropositivity (HBV+)/hepatitis C virus seropositivity (HCV+), and trial.
RESULTS: Participants with serum ferritin in the highest quartile, as compared with those in the lowest quartile, had an increased risk of CLD mortality (odds ratio = 1.72, 95% confidence interval = 1.12, 2.64, P-trend < 0.01). Moreover, the association with higher serum ferritin was stronger among alcohol drinkers and those who were HCV+ (P-interaction < 0.05). For incident liver cancer, risk estimates were above one but were not statistically significant.
CONCLUSIONS: In this study, higher levels of serum ferritin at baseline were associated with subsequent mortality from CLD, particularly if combined with alcohol drinking or viral hepatitis. Further work is warranted to confirm our findings.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening disorder, characterized by a hyperimmune response. The mortality is high despite progress being made in the diagnosis and treatment of the disease. HLH is traditionally divided into primary (familial or genetic) and secondary (reactive) according to the etiology. Secondary HLH (sHLH), more common in adults, is often associated with underlying conditions including severe infections, malignancies, autoimmune diseases, or other etiologies.
METHODS: The case involves a 31-year-old woman, presented with a high persistent fever, rash, and splenomegaly. She met the diagnostic criteria of the HLH-2004 guideline and thus was diagnosed with HLH, with positive anti-nuclear antibody (ANA) and positive cytomegalovirus (CMV)-DNA. The patient responded well to a combination of immunomodulatory, chemotherapy, and supportive treatments. When her PCR evaluation for CMV turned negative, her serum ferritin also dropped significantly. Her clinical symptoms improved dramatically, and except for ANA, the abnormal laboratory findings associated with HLH returned to normal. Our previous study has shown that the median overall survival of HLH patients is only 6 mo; however, our patient has been cured and has not presented with any relapse of the disease for 6 years.
CONCLUSIONS: This case emphasizes that thorough early removal of the CMV infection is significant for the prognosis of this HLH patient.