Modulation of iron status biomarkers in tuberculosis-diabetes co-morbidity

Strongyloidiasis stercoralis coinfection is associated with altered iron status biomarkers in tuberculous lymphadenitis

Soil-transmitted helminth [mainly Strongyloidiasis stercoralis (Ss)] and tuberculous lymphadenitis (TBL) coinfection in humans is a significant public health problem. We have previously shown that TBL+Ss+ coinfection significantly alters diverse cytokine, matrix metalloproteinase, and tissue inhibitors of metalloproteinase profiles. However, no data is available to understand the influence of Ss coinfection in TBL disease with respect to iron status biomarkers. Hence, we have studied the effect of Ss coinfection on the circulating levels of iron status (ferritin, transferrin [TF], apotransferrin [ApoT], hepcidin, hemopexin) biomarkers in TBL disease. Our results show that TBL+Ss+ and/or TBL+Ss- individuals are associated with significantly altered biochemical and hematological (red blood cell (RBC) counts, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) were decreased, and platelets were increased) parameters compared to TBL-Ss+ individuals. Our results also show that TBL+Ss+ coinfection is associated with diminished circulating levels of ferritin, ApoT, hepcidin, and hemopexin compared to TBL+Ss- individuals. TBL+Ss+ and TBL+Ss- groups are associated with altered iron status biomarkers (decreased ferritin [TBL+Ss+ alone] and increased TF, ApoT, hepcidin and hemopexin [TBL+Ss- alone]) compared to TBL-Ss+ group. The heat map expression profile and principal component analysis (PCA) analysis of iron status biomarkers were significantly altered in TBL+Ss+ compared to TBL+Ss- and/or TBL-Ss+ individuals. A significant correlation (positive/negative) was obtained among the biochemical and hematological parameters (white blood cells (WBC)/ferritin, TF, and hepcidin, mean corpuscular hemoglobin concentration (MCHC)/ferritin and hemopexin) with iron status biomarkers. Finally, receiver operating characteristic (ROC) analysis revealed that hemopexin was significantly associated with greater specificity and sensitivity in discriminating TBL+Ss+ and TBL+Ss- coinfected individuals. Thus, our data conclude that Ss coinfection is associated with altered iron status biomarkers indicating that coinfection might alter the host-Mtb interface and could influence the disease pathogenesis.

Risk factors of latent tuberculosis among chronic kidney disease with routine haemodialysis patients

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Since tuberculosis still become an important health problem in the world, especially in developing countries, CKD patients also become a high-risk population to TBC infection.

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Due to immunity impairment in CKD patients, particularly who are routinely hemodialyzed, tuberculosis is not always clinically manifested (latent).

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However, tuberculosis among CKD patients contribute to greater morbidity, quality of life and morbidity. Hence, we investigated the factors that associated with latent tuberculosis among CKD on haemodialysis patients.

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By understanding it, management of CKD patients could be more comprehensive, and the morbidity and mortality could be decreased while quality of life could be increased.

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We also provide the first documentation study of tuberculosis among CKD on haemodialysis patients in Indonesia, one of the tuberculosis endemic country.

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According our study, smoking status and HD adequacy based on URR < 73% are associated factors that contribute to LTB among CKD on HD patients.

Introduction

Methods

Results

Conclusion

The Relationship between Nutritional Status and Latent Tuberculosis in Routine Hemodialysis

BACKGROUND: Malnutrition in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) interferes with the natural and adaptive immune response, consequently, increasing the latent tuberculosis (TB) reactivation. AIM: This study therefore aims to determine the relationship between nutritional status and latent TB in routine HD, using interferon gamma release assays (IGRA), to screen for latent TB. METHODS AND STUDY DESIGN: This study has an analytical observation cross-sectional design, and was conducted on 120 CKD-HD patients aged 18 years and above, and has been undergoing HD twice weekly for over 3 months, without malignancy, human immunodeficiency virus/acquired immunodeficiency syndrome, history of TB, or radiological evidence at the HD Unit of the Dr. Hasan Sadikin Hospital, Bandung, Indonesia, between March and May 2020, and not currently receiving immunosuppressant or TB therapy. In addition, the age, gender, history of Bacille Calmette-Guerin vaccine, CKD etiology, length of HD, HD adequacy, TB contact history, number of family members, smoking status, body mass index, albumin, malnutrition inflammation score, triceps skinfold thickness (TST), biceps skinfold thickness, suprailiac skinfold thickness (SIST), mid-upper arm circumference (MAC), and normalized protein catabolic rate between positive and negative IGRA groups, of each patient, were determined. RESULTS: In this study, all the patients met the inclusion and exclusion criteria. Based on the IGRA test, 47 patients (39.17%) tested positive, and 68 (56.67%) tested negative, while the results for the remaining 5 (4.16%) were indeterminate. The malnutrition inflammation score (MIS) score with positive IGRA 23.3 (20.0–26.7) was discovered to differ insignificantly (p value of 0.252) from the negative counterpart 20.0 (16.7–28.4). Meanwhile, in the HD adequacy assessment based on urea reduction rate, a statistically significant difference (p = 0.042) occurred between the positive 70.45 (65.70–76.61) and negative 74.15 (70.71–77.33) IGRA groups. In the smoking status, the positive and negative IGRA were discovered to differ significantly (30 (63.8% vs. 28 (41.2% p = 0.017) OR 2.521 (1.172–5.425). However, in the history of contact with TB patients, the positive and negative IGRA did not differ significantly (4.3% vs. 11.8% p = 0.160). Furthermore, there was a significant difference in TST and MAC, between MIS >5 and MIS ≤5 (p < 0.05). CONCLUSION: The assessment of nutritional status level, TST, MAC, smoking status, and adequate HD is crucial for CKD patients with routine HD, as these factors present risks of latent TB.

Relation between Level of Serum Transferrin and Postoperative Wound Drainage in Closed Long Bone Fractures

OBJECTIVE

To report association between the serum transferrin level and postoperative wound drainage in closed long bone fractures.

SUMMARY OF BACKGROUND DATA

There is an old association between the serum transferrin level and wound drainage leading to peri-implant infection. There is no literature available on the ideal treatment for wound drainage. In the majority of the cases, wound drainage usually stops in 3-5 days postoperatively. However, very few cases have been described in the literature about wound drainage following closed long bone fractures.

METHODS

A prospective review of the patient's serum transferrin levels and postoperative wound drainage is done.

RESULTS

We reviewed records of 100 patients in whom levels of serum transferrin were checked preoperatively and correlated with postoperative wound discharge. Out of the 100 patients whose serum transferrin levels were checked, 23 patients had low serum transferrin levels and 19 patients had postoperative wound discharge. Out of these 19 patients, 16 patients had low serum transferrin levels. Thus, sensitivity of the test was 84.2% and specificity was 91.3%. In addition, the positive predictive value was 70% and negative predictive value was 96%.

CONCLUSION

We report that preoperative serum transferrin levels can be used as a good marker to judge postoperative wound drainage in closed long bone fractures.