Early Diagnosis of Iron Deficiency in School Children: A Qatari Experience

Objective: Iron deficiency still remains the most common nutritional deficiency throughout the world and is the leading cause of anaemia in children. Early recognition of iron deficiency, even before the development of anaemia is crucial to prevent the systemic complications of this disease. Methods: Ninety-seven school children between 5 and 16 years were stratified into prelatent iron deficiency (10 cases), latent iron deficiency (14 cases), overt iron deficiency anemia (13 cases), and controls (60 cases). All hemograms were performed on the same day of collection using the same Sysmex XE-2100 analyzer with reticulocyte indices included. Biochemical markers such serum iron, total iron binding capacity and percent saturation (calculated) in addition to serum ferritin and serum transferrin receptors were simultaneously measured. Data analysis was done using ANOVA test, generalized linear regression, and ROC curve. Results: Our study indicates that a panel based on hematologic parameters including reticulocyte hemoglobin at a cut off of ≤27 and ≤25.6, serum transferrin receptors at a cut off >0.48 and >0.68, red cell distribution width at a cut off >13.8 and >16.8 may provide an alternative to the traditional biochemical panels for the diagnosis of latent iron deficiency and overt iron deficiency anemia respectively. Conclusion: Whenever iron deficiency is thought of, a hemogram including reticulocyte hemoglobin and serum transferrin receptors would be the adequate diagnostic panel obviating the need for a more extensive one. These parameters should always be interpreted in the clinical context involving dietary habits, social standard as well as family history

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

The impact of viral mutations on recognition by SARS-CoV-2 specific T cells.

We identify amino acid variants within dominant SARS-CoV-2 T cell epitopes by interrogating global sequence data. Several variants within nucleocapsid and ORF3a epitopes have arisen independently in multiple lineages and result in loss of recognition by epitope-specific T cells assessed by IFN-γ and cytotoxic killing assays. Complete loss of T cell responsiveness was seen due to Q213K in the A∗01:01-restricted CD8+ ORF3a epitope FTSDYYQLY207-215; due to P13L, P13S, and P13T in the B∗27:05-restricted CD8+ nucleocapsid epitope QRNAPRITF9-17; and due to T362I and P365S in the A∗03:01/A∗11:01-restricted CD8+ nucleocapsid epitope KTFPPTEPK361-369. CD8+ T cell lines unable to recognize variant epitopes have diverse T cell receptor repertoires. These data demonstrate the potential for T cell evasion and highlight the need for ongoing surveillance for variants capable of escaping T cell as well as humoral immunity.This work is supported by the UK Medical Research Council (MRC); Chinese Academy of Medical Sciences(CAMS) Innovation Fund for Medical Sciences (CIFMS), China; National Institute for Health Research (NIHR)Oxford Biomedical Research Centre, and UK Researchand Innovation (UKRI)/NIHR through the UK Coro-navirus Immunology Consortium (UK-CIC). Sequencing of SARS-CoV-2 samples and collation of data wasundertaken by the COG-UK CONSORTIUM. COG-UK is supported by funding from the Medical ResearchCouncil (MRC) part of UK Research & Innovation (UKRI),the National Institute of Health Research (NIHR),and Genome Research Limited, operating as the Wellcome Sanger Institute. T.I.d.S. is supported by a Well-come Trust Intermediate Clinical Fellowship (110058/Z/15/Z). L.T. is supported by the Wellcome Trust(grant number 205228/Z/16/Z) and by theUniversity of Liverpool Centre for Excellence in Infectious DiseaseResearch (CEIDR). S.D. is funded by an NIHR GlobalResearch Professorship (NIHR300791). L.T. and S.C.M.are also supported by the U.S. Food and Drug Administration Medical Countermeasures Initiative contract75F40120C00085 and the National Institute for Health Research Health Protection Research Unit (HPRU) inEmerging and Zoonotic Infections (NIHR200907) at University of Liverpool inpartnership with Public HealthEngland (PHE), in collaboration with Liverpool School of Tropical Medicine and the University of Oxford.L.T. is based at the University of Liverpool. M.D.P. is funded by the NIHR Sheffield Biomedical ResearchCentre (BRC – IS-BRC-1215-20017). ISARIC4C is supported by the MRC (grant no MC_PC_19059). J.C.K.is a Wellcome Investigator (WT204969/Z/16/Z) and supported by NIHR Oxford Biomedical Research Centreand CIFMS. The views expressed are those of the authors and not necessarily those of the NIHR or MRC

Hyperpolarized F-19-MRI: parahydrogen-induced polarization and field variation enable F-19-MRI at low spin density

The use of parahydrogen-induced polarization (PHIP) for signal enhancement in nuclear magnetic resonance spectroscopy (NMR) is well established. Recently, this method has been adopted to increase the sensitivity of magnetic resonance imaging (MRI). The transfer of non-thermal spin hyperpolarization-from parahydrogen to a heteronucleus-provides better contrast, thus enabling new imaging agents. The unique advantage of F-19-MRI is that it provides non-invasive and background-free active marker signals in biomedical applications, such as monitoring drugs that contain F-19. In former NMR spectroscopic experiments, hyperpolarized F-19 nuclei were efficiently generated by using low magnetic field (Earth's field) conditions. In order to apply the method to F-19-hyperpolarized MRI, we chose an exploratory target molecule, for which a successful transfer of PHIP had already been attested. The transfer of hyperpolarization to F-19 was further optimized by adequate field manipulations below Earth's magnetic field. This technique, called field cycling, led to a signal enhancement of about 60. For the first time, hyperpolarized F-19-MR images were received. Despite the low spin density of the sample (0.045 of the H-1 density in H2O), a sufficient signal-to-noise was obtained within a short acquisition time of 3.2 s

Insights into the antibacterial mechanism of action of chelating agents by selective deprivation of iron, manganese and zinc

Bacterial growth and proliferation can be restricted by limiting the availability of metal ions in their environment. Humans sequester iron, manganese and zinc to help prevent infection by pathogens, a system termed nutritional immunity. Commercially-used chelants have high binding affinities with a variety of metal ions, which may lead to antibacterial properties that mimic these innate immune processes. However, the modes of action of many of these chelating agents in bacterial growth inhibition and their selectivity in metal deprivation in cellulo remain ill-defined. We address this shortcoming by examining the effect of eleven chelators on Escherichia coli growth and their impact on the cellular concentration of five metals. Four distinct effects were uncovered: i) no apparent alteration in metal composition, ii) depletion of manganese alongside reductions in iron and zinc levels, iii) reduced zinc levels with a modest reduction in manganese, and iv) reduced iron levels coupled with elevated manganese. These effects do not correlate with the absolute known chelant metal ion affinities in solution, however, for at least five chelators for which key data are available, they can be explained by differences in the relative affinity of chelants for each metal ion. The results reveal significant insights into the mechanism of growth inhibition by chelants, highlighting their potential as antibacterials and as tools to probe how bacteria tolerate selective metal deprivation

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease