Iron loading in humans: A risk factor for enhanced morbidity and mortality

Evaluation of continuous glucose monitoring system for detection of alterations in glucose homeostasis in pediatric patients with β-thalassemia major

BACKGROUND

Disturbances of glucose metabolism are common in β-thalassemia major (β-TM).

AIM

This study was conducted to assess the pattern of glucose homeostasis in pediatric β-TM patients comparing oral glucose tolerance test (OGTT) and continuous glucose monitoring system (CGMS).

METHODS

Two-hundred β-TM patients were studied and those with random blood glucose (RBG) ≥7.8 mmol/L (140 mg/dL) were subjected to OGTT, insertion of CGMS and measurement of fasting C peptide, fasting insulin, and hemoglobin A1c (HbA1c).

RESULTS

Twenty patients (10%) had RBG ≥ 7.8 mmol/L. Using OGTT, 6 out of 20 patients (30%) had impaired glucose tolerance (IGT) while 7 (35%) patients were in the diabetic range. CGMS showed that 7/20 (35%) patients had IGT and 13 (65%) patients had diabetes mellitus (DM); 10 of the latter group had HbA1c readings within diabetic range. The percentage of diabetic patients diagnosed by CGMS was significantly higher than that with OGTT (P = 0.012). Serum ferritin was the only independent variable related to elevated RBG. All β-TM patients with DM were non-compliant to chelation therapy.

CONCLUSIONS

The use of CGMS in the diagnosis of early glycemic abnormalities among pediatric patients with β-TM appears to be superior to other known diagnostic modalities.

Tobacco smoke iron: an initiator/promoter of multiple diseases

Tobacco smoking enhances risk for a diversity of acute and chronic diseases. Iron is a constant prominent component of mainstream tobacco smoke. The manifold toxic activities of inhaled iron could be responsible for a notable portion of the spectrum of smoking-related diseases.

Iron availability and infection

BACKGROUND

To successfully sustain an infection, nearly all bacteria, fungi and protozoa require a continuous supply of host iron.

METHODS

Literature review.

RESULTS

Mechanisms of microbial iron acquisition are determinants for the kinds of cells, tissues and hosts in which pathogens can flourish. As a corollary, hosts possess an array of iron withholding devices whereby they can suppress or abort microbial invasions.

GENERAL SIGNIFICANCE

Awareness of environmental and behavioral methods that can prevent iron loading plus development of pharmaceutical agents that can block microbial access to iron may help to reduce our dependence on antibiotics.

Iron out-of-balance: a risk factor for acute and chronic diseases

The numerous acute and chronic diseases associated with excessive/misplaced iron are categorized in this review in the following sections: 1) iron, by itself, can initiate the disease; 2) iron can be a cofactor in promoting the disease; 3) iron deposits are observed in disease-associated tissue sites; 4) body iron loading is associated with above normal incidence of the disease; and 5) maternal antibodies can impair fetal iron metabolism. Also discussed is the anomalous condition in which persons whose macrophages are low in iron are resistant to microbial pathogens that require iron loaded macrophages for in vivo growth. Thus, hemochromatotic mutations have apparently had survival value during outbreaks of tuberculosis, plague and typhoid fever.