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Kearson L, Dandar C, Hoyt C, Longoria J, Okhomina V, Raches D, Potter B, Kang G, Hankins J, Takemoto C, Heitzer A. Prediction of Functional Academic Outcomes by Fine Motor Skills in Individuals With Sickle Cell Disease. Am J Occup Ther 2024; 78:7805205180. [PMID: 39102271 DOI: 10.5014/ajot.2024.050684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
IMPORTANCE Individuals with sickle cell disease (SCD) are at heightened risk of poor neurocognitive and academic outcomes. The relationship between fine motor skills and academic outcomes is not well understood. OBJECTIVE To compare the fine motor skills of individuals with SCD with normative expectations, test whether demographic and medical factors are associated with fine motor performance, and determine the impact of fine motor performance on academic performance. DESIGN Cross-sectional. SETTING St. Jude Children's Research Hospital. PARTICIPANTS Individuals with SCD (N = 376; ages 8-24 yr). OUTCOMES AND MEASURES Fine motor outcomes included visual-motor integration, manual dexterity, and graphomotor speed. Academic outcomes included math fluency and word reading. Demographic and medical variables were obtained via medical records and interviews. RESULTS Compared with normative expectations, the performance of individuals with SCD on all fine motor measures was lower than expected. Male sex, lower socioeconomic status, and lower oxygen saturation was associated with slower graphomotor speed. Lower socioeconomic status and older age were associated with lower visual-motor integration scores. Performance on all fine motor measures was positively associated with math fluency and word reading. CONCLUSIONS AND RELEVANCE Individuals with SCD exhibited poorer than expected fine motor skills across multiple motor domains, and these deficits were associated with poorer academic outcomes. Early referral to intervention services for fine motor skills may facilitate improved academic outcomes for individuals with SCD. Plain-Language Summary: This study had three objectives: (1) Compare the fine motor skills of people with sickle cell disease (SCD) with normative expectations, (2) test whether demographic and medical factors are associated with fine motor performance, and (3) determine the impact of fine motor performance on academic performance. We found that SCD is a risk factor for lower than expected fine motor performance across multiple fine motor domains and that these deficits also affect functional academic skills.
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Affiliation(s)
- Lakia Kearson
- Lakia Kearson, PsyD, is Neuropsychology Fellow, Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Christina Dandar
- Christina Dandar, MA, is Neuropsychology Intern, Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Catherine Hoyt
- Catherine Hoyt, PhD, OTD, FAOTA, OTR/L, is Assistant Professor of Occupational Therapy, Neurology, and Pediatrics, Department of Pediatrics and Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Jennifer Longoria
- Jennifer Longoria, PhD, is Neuropsychologist, Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Victoria Okhomina
- Victoria Okhomina, MPH, MS, is Biostatistician, Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Darcy Raches
- Darcy Raches, PhD, is Neuropsychologist, Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Brian Potter
- Brian Potter, PhD, is Neuropsychologist, Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Guolian Kang
- Guolian Kang, PhD, is Biostatistician, Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Jane Hankins
- Jane Hankins, MD, is Director of Global Hematology Program, Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Clifford Takemoto
- Clifford Takemoto, MD, is Director of Clinical Hematology, Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew Heitzer
- Andrew Heitzer, PhD, is Neuropsychologist, Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN;
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Zhang T, Gao C, Chen W, Ma H, Tao L. Patent Foramen Ovale in Children: A Review of Recent Progress. Pediatr Cardiol 2024:10.1007/s00246-024-03526-5. [PMID: 38822852 DOI: 10.1007/s00246-024-03526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
The support has been provided by clinical trials and guidelines for managing patent foramen ovale (PFO) in adults; however, the optimal approach is still unclear for treating PFO in pediatric patients. PFO and its associated clinical syndromes, imaging diagnosis, and management in pediatric patients were analyzed by a comprehensive analysis. Extensive research was performed using electronic databases, including PubMed, Cochrane, Web of Science, and EMBASE. This review includes the studies published until February 1st, 2024. A total of 583 articles were obtained, of which 54 were included in the comprehensive review. Numerous evidences have indicated that a right-to-left shunt through a PFO may be involved in cryptogenic stroke in children, although the connection between migraine and aura has not been substantiated by robust evidence. Children with sickle cell disease and a PFO were at higher risks of paradoxical embolization, rare syndromes caused by PFO could also occur in children such as platypnea-orthodeoxia syndrome, myocardial infarction, and decompression sickness. Contrast transthoracic echocardiography was deemed the most appropriate examination for children due to its favorable transthoracic windows, eliminating the need for anesthesia. This review suggested that the additional treatment was not needed as no evidence was provided for potential future complications linked to isolated PFO in children. For children facing unique circumstances related to PFO, a customized interdisciplinary consultation is essential prior to considering medical interventions.
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Affiliation(s)
- Tingting Zhang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Changle West Road, Xi'an, 710032, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Changle West Road, Xi'an, 710032, China
| | - Wei Chen
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Changle West Road, Xi'an, 710032, China
| | - Hui Ma
- Department of Ultrasound Diagnostics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Changle West Road, Xi'an, 710032, China.
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Luo J, Powell J, Ross S, Johnson J, Olopade CO, Pinto J, Kim K, Ahsan H, Aschebrook-Kilfoy B. Evaluating the impact of sickle cell disease on COVID-19 susceptibility and severity: a retrospective cohort study based on electronic health record. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1241645. [PMID: 38455889 PMCID: PMC10910923 DOI: 10.3389/fepid.2023.1241645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/28/2023] [Indexed: 03/09/2024]
Abstract
Background Sickle cell trait/disease (SCT/SCD) are enriched among Black people and associated with various comorbidities. The overrepresentation of these characteristics prevents traditional regression approach obtaining convincing evidence for the independent effect of SCT/SCD on other health outcomes. This study aims to investigate the association between SCT/SCD and COVID-19-related outcomes using causal inference approaches that balance the covariate. Methods We leveraged electronic health record (EHR) data from the University of Chicago Medicine between March 2020 and December 2021. Demographic characteristics were retrieved. Medical conditions were identified using ICD-10 codes. Five approaches, including two traditional regression approaches (unadjusted and adjusted) and three causal inference approaches [covariate balancing propensity score (CBPS) matching, CBPS weighting, and CBPS adjustment], were employed. Results A total of 112,334 patients were included in the study, among which 504 had SCT and 388 SCD. Patients with SCT/SCD were more likely to be non-Hispanic Black people, younger, female, non-smokers, and had a diagnosis of diabetes, heart failure, asthma, and cerebral infarction. Causal inference approaches achieved a balanced distribution of these covariates while traditional approaches failed. Across these approaches, SCD was consistently associated with COVID-19-related pneumonia (odds ratios (OR) estimates, 3.23 (95% CI: 2.13-4.89) to 2.57 (95% CI: 1.10-6.00)) and pain (OR estimates, 6.51 (95% CI: 4.68-9.06) to 2.47 (95% CI: 1.35-4.49)). While CBPS matching suggested an association between SCD and COVID-19-related acute respiratory distress syndrome (OR = 2.01, 95% CI: 0.97-4.17), this association was significant in other approaches (OR estimates, 2.96 (95% CI: 1.69-5.18) to 2.50 (95% CI: 1.43-4.37)). No association was observed between SCT and COVID-19-related outcomes in causal inference approaches. Conclusion Using causal inference approaches, we provide comprehensive evidence for the link between SCT/SCD and COVID-19-related outcomes.
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Affiliation(s)
- Jiajun Luo
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, United States
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| | - Johnny Powell
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, United States
| | - Sage Ross
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, United States
| | - Julie Johnson
- Center for Research Informatics, University of Chicago, Chicago, IL, United States
| | | | - Jayant Pinto
- Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Karen Kim
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, United States
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| | - Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, United States
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
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Okar L, Ali Alzoubi H, Shukur Mahmud S, Elyas A, Yassin MA. Dilemma in approach to stroke in sickle cell disease patient: A case report. Medicine (Baltimore) 2022; 101:e29131. [PMID: 35839057 PMCID: PMC11132328 DOI: 10.1097/md.0000000000029131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cerebrovascular accidents in sickle cell disease (SCD) patients carry a high socioeconomic impact and represent the most important cause of morbidity, neurological deficits, and impaired quality of life in SCD young population.Patent foramen ovale (PFO) is prevalent in 25% of the general population and it is associated with ischemic stroke in the young population via paradoxical embolism, yet there are no specific guidelines to address how to manage SCD patients with PFO who suffer a stroke. PATIENT CONCERNS AND DIAGNOSIS Here we present a young SCD patient, aged 24 years, who suffered a stroke in childhood and later was discovered to have a PFO on subsequent echocardiography. The patient has been receiving blood transfusion therapy since 3 years of age. INTERVENTIONS AND OUTCOMES No treatment was administered to the patient.The intervention that was done was echocardiography with a bubble study to detect PFO. CONCLUSION Recommendations need to be put in place regarding screening for PFO in patients with SCD, in addition to highlighting issues of whether screening needs to be done in patients who have not developed stroke, and if PFO were to be found, what would be the best management approach and how will prognosis be affected.
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Affiliation(s)
- Lina Okar
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Ahmed Elyas
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A. Yassin
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
- Department of Cardiology, Hamad Medical Corporation, Doha, Qatar
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Hoogenboom WS, Alamuri TT, McMahon DM, Balanchivadze N, Dabak V, Mitchell WB, Morrone KB, Manwani D, Duong TQ. Clinical outcomes of COVID-19 in patients with sickle cell disease and sickle cell trait: A critical appraisal of the literature. Blood Rev 2022; 53:100911. [PMID: 34838342 PMCID: PMC8605823 DOI: 10.1016/j.blre.2021.100911] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023]
Abstract
Individuals with sickle cell disease (SCD) and sickle cell trait (SCT) have many risk factors that could make them more susceptible to COVID-19 critical illness and death compared to the general population. With a growing body of literature in this field, a comprehensive review is needed. We reviewed 71 COVID-19-related studies conducted in 15 countries and published between January 1, 2020, and October 15, 2021, including a combined total of over 2000 patients with SCD and nearly 2000 patients with SCT. Adults with SCD typically have a mild to moderate COVID-19 disease course, but also a 2- to 7-fold increased risk of COVID-19-related hospitalization and a 1.2-fold increased risk of COVID-19-related death as compared to adults without SCD, but not compared to controls with similar comorbidities and end-organ damage. There is some evidence that persons with SCT have increased risk of COVID-19-related hospitalization and death although more studies with risk-stratification and properly matched controls are needed to confirm these findings. While the literature suggests that most children with SCD and COVID-19 have mild disease and low risk of death, some children with SCD, especially those with SCD-related comorbidities, are more likely to be hospitalized and require escalated care than children without SCD. However, children with SCD are less likely to experience COVID-19-related severe illness and death compared to adults with or without SCD. SCD-directed therapies such as transfusion and hydroxyurea may be associated with better COVID-19 outcomes, but prospective studies are needed for confirmation. While some studies have reported favorable short-term outcomes for COVID-19 patients with SCD and SCT, the long-term effects of SARS-CoV-2 infection are unknown and may affect individuals with SCD and SCT differently from the general population. Important focus areas for future research should include multi-center studies with larger sample sizes, assessment of hemoglobin genotype and SCD-modifying therapies on COVID-19 outcomes, inclusion of case-matched controls that account for the unique sample characteristics of SCD and SCT populations, and longitudinal assessment of post-COVID-19 symptoms.
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Affiliation(s)
- Wouter S. Hoogenboom
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA,Corresponding authors at: Albert Einstein College of Medicine and Montefiore Medical Center, Department of Radiology, 1300 Morris Park Avenue, Bronx, New York 10461, USA
| | - Tharun T. Alamuri
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
| | - Daniel M. McMahon
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
| | - Nino Balanchivadze
- Department of Hematology and Oncology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Vrushali Dabak
- Department of Hematology and Oncology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - William B. Mitchell
- Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
| | - Kerry B. Morrone
- Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
| | - Tim Q. Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA,Corresponding authors at: Albert Einstein College of Medicine and Montefiore Medical Center, Department of Radiology, 1300 Morris Park Avenue, Bronx, New York 10461, USA
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Lin TY, Fu YC, Jan SL, Lin MC. Detecting Patent Foramen Ovale after Cryptogenic Stroke - A Single Center Experience in Taiwan. ACTA CARDIOLOGICA SINICA 2022; 38:373-380. [PMID: 35673343 PMCID: PMC9121751 DOI: 10.6515/acs.202205_38(3).20211228a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/28/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cryptogenic strokes related to a patent foramen ovale (PFO) in young patients have been reported. Percutaneous transcatheter occlusion is considered a safe and effective method for achieving PFO closure. Here, we present our experience of PFO closure in a series of young patients diagnosed with cryptogenic stroke. METHODS This was a retrospective study of 62 patients who were younger than 60 years of age and previously diagnosed with cryptogenic stroke. They underwent cardiac catheterization for the diagnosis of PFO and/or device closure. Bubble and echocardiography studies, the patients' characteristics, complications, and recurrence of stroke were recorded. The Risk of Paradoxical Embolism (RoPE) score index was also calculated. RESULTS Patients with a bubble study grade greater than grade I were likely to have PFO (odds ratio: 22.2 [95% confidence interval: 1.2-412.3]). The mean RoPE score in the PFO closure group was 7.18. Two patients (3.9%) developed atrial fibrillation during the procedure. Ischemic stroke recurred in two patients (3.3%). CONCLUSIONS Combining a bubble study with transcranial Doppler ultrasound or transthoracic echocardiography may increase the validity of PFO diagnosis. Because of the low recurrence rate of stroke and low complication rate, it is important to identify PFO patients with a bubble study grade greater than grade I. Closure of PFO may be a good strategy for preventing recurrent stroke among such patients.
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Affiliation(s)
- Ting-Yu Lin
- Children’s Medical Center, Taichung Veterans General Hospital
| | - Yun-Ching Fu
- Children’s Medical Center, Taichung Veterans General Hospital
| | - Sheng-Ling Jan
- Children’s Medical Center, Taichung Veterans General Hospital;
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Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University
| | - Ming-Chih Lin
- Children’s Medical Center, Taichung Veterans General Hospital;
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Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University;
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Department of Food and Nutrition, Providence University;
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School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Galadanci NA, Johnson W, Carson A, Hellemann G, Howard V, Kanter J. Association Between Patent Foramen Ovale and Overt Ischemic Stroke in Children With Sickle Cell Disease. Front Neurol 2021; 12:761443. [PMID: 34966346 PMCID: PMC8710657 DOI: 10.3389/fneur.2021.761443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Ischemic stroke is one of the most devastating complications of sickle cell anemia (SCA). Previous studies have shown that intracardiac shunting including patent foramen ovale (PFO) can be a potential risk factor for stroke in children with SCA. This study investigates the association between PFO and overt ischemic stroke in the DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study cohort of 5,247 children with SCA of whom 1,414 had at least one clinical non-contrast transthoracic echocardiogram. Presence of PFO was taken from the clinical report. Further, we assessed the association between PFO and other clinical and hemolytic factors in children with SCA such as history of abnormal sickle stroke screen [elevated Transcranial Doppler ultrasound (TCD) velocity] and patient's baseline hemoglobin. In 642 children for whom all data were available, the adjusted odds ratio (OR) for overt stroke was higher in those with PFO but this was not statistically significant (OR: 1.49, 95% CI: 0.20-11.03, p = 0.6994). With an OR of 0.85, the study suggested less PFOs in those with abnormal TCD, but this was not statistically significant (95% CI: 0.17-4.25, p = 0.8463). Overall, the prevalence of PFO in this large sub study of non-contrast echocardiography amongst children with SCA is much lower than previous smaller studies using bubble contrast echocardiography. Overt stroke was non-statistically more common in children with SCA and PFO, but there was no evidence that PFO was more common in those with abnormal TCD, the most important pediatric sickle stroke screen.
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Affiliation(s)
- Najibah A Galadanci
- Division of Hematology and Oncology, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Walter Johnson
- Department of Pediatrics, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - April Carson
- Jackson Heart Study, University of Mississipi Medical Center, Jackson, MS, United States
| | - Gerhard Hellemann
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Virginia Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Julie Kanter
- Division of Hematology and Oncology, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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