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Shamoon RP, Charkaneh A, Di Pierro E, Irrera M, Curcio C, Yassin A, Khailany RA. Hb SKMC and an unprecedented γδβ-thalassemia: first report from Iraq. Hematology 2024; 29:2399356. [PMID: 39252479 DOI: 10.1080/16078454.2024.2399356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 08/26/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Thalassemias are genetic disorders of globin chain synthesis. In Iraq, β-thalassemia is more prevalent than α-thalassemia. This study identifies two unpredicted globin gene mutations, a rare α-globin gene mutation (Hb SKMC) and a novel γδβ-thalassemia deletion. METHODS Over 2 years, the Genetics unit at PAR hospital in Erbil, northern Iraq processed 137 β-thalassemia and 97 α-thalassemia genetic testing requests. Three symptomatic thalassemia cases with unreported genotypes were identified. Proband-1α and proband-2α had Hb H disease, while proband-1β had severe transfusion-dependent β-thalassemia (TDT). Molecular studies included multiplex PCR, reverse hybridization, multiplex ligation-dependent probe amplification (MLPA), and globin gene sequencing. RESULTS The α-thalassemia probands exhibited moderate microcytic hypochromic anemia with irregular transfusions and splenomegaly. Hb H disease was confirmed by positive Hb H tests and high-performance liquid chromatography (HPLC). Molecular analysis revealed heterozygous -MED deletion in proband-1α and α2Poly-A2 mutation in proband-2α. Sequencing identified the Hb SKMC (HBA1:c.283_300+3dup) mutation in both probands. The β-thalassemia proband showed anemia and regular transfusions. Molecular studies detected the IVS1.110 G>A mutation and a novel γδβ-thalassemia deletion in compound heterozygous form. The maternal sample showed the IVS1.110 G>A mutation, and MLPA confirmed the γδβ-thalassemia deletion in the paternal sample. CONCLUSION These findings highlight the genetic diversity of thalassemias in the region and emphasize the importance of advanced molecular diagnostics in detecting rare mutations.
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Affiliation(s)
- Rawand P Shamoon
- Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq
- Department of Laboratory Medical Sciences, College of Health Sciences, Catholic University in Erbil, Erbil, Iraq
- Department of Hematology, Nanakali Hospital of Blood Diseases and Cancer, Erbil, Iraq
- Department of Hematology, Thalassemia Care Center, Erbil, Iraq
- Genetics Unit, Laboratory Division, PAR Private Hospital, Erbil, Iraq
- Department of Preclinical Sciences, Division of Pathology, School of Medicine, University of Kurdistan Hawler, Erbil, Iraq
| | - Amir Charkaneh
- Genetics Unit, Laboratory Division, PAR Private Hospital, Erbil, Iraq
| | - Elena Di Pierro
- Medicine and Metabolic Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Milena Irrera
- Clinical Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Curcio
- Clinical Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ahmed Yassin
- Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
- Department of Clinical Hematology, Nanakali Hospital for Blood Diseases and Cancer, Erbil, Iraq
| | - Rozhgar A Khailany
- Department of Microbiology and Genetics, College of Medicine, Hawler Medical University, Erbil, Iraq
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AlAnazi MM, Ventura EF, Lovegrove JA, Vimaleswaran KS. A Systematic Review of the Gene-Lifestyle Interactions on Metabolic Disease-Related Outcomes in Arab Populations. Nutrients 2024; 16:2519. [PMID: 39125399 PMCID: PMC11314532 DOI: 10.3390/nu16152519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/18/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
The increased prevalence of metabolic diseases in the Arab countries is mainly associated with genetic susceptibility, lifestyle behaviours, such as physical inactivity, and an unhealthy diet. The objective of this review was to investigate and summarise the findings of the gene-lifestyle interaction studies on metabolic diseases such as obesity and type 2 diabetes in Arab populations. Relevant articles were retrieved from a literature search on PubMed, Web of Science, and Google Scholar starting at the earliest indexing date through to January 2024. Articles that reported an interaction between gene variants and diet or physical activity were included and excluded if no interaction was investigated or if they were conducted among a non-Arab population. In total, five articles were included in this review. To date, among three out of twenty-two Arab populations, fourteen interactions have been found between the FTO rs9939609, TCF7L2 rs7903146, MC4R rs17782313, and MTHFR rs1801133 polymorphisms and diet or physical activity on obesity and type 2 diabetes outcomes. The majority of the reported gene-diet/ gene-physical activity interactions (twelve) appeared only once in the review. Consequently, replication, comparisons, and generalisation of the findings are limited due to the sample size, study designs, dietary assessment tools, statistical analysis, and genetic heterogeneity of the studied sample.
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Affiliation(s)
- Maria M. AlAnazi
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading RG6 6DZ, UK; (M.M.A.); (J.A.L.)
- Department of Human Nutrition, College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar
| | - Eduard Flores Ventura
- Institute of Agrochemistry and Food Technology—Spanish National Research Council (IATA-CSIC), 46980 Valencia, Spain;
| | - Julie A. Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading RG6 6DZ, UK; (M.M.A.); (J.A.L.)
| | - Karani Santhanakrishnan Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading RG6 6DZ, UK; (M.M.A.); (J.A.L.)
- Institute for Food, Nutrition and Health (IFNH), University of Reading, Reading RG6 6AH, UK
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Alkamali A, Alshafiei LS, AlJasmi M, Helali H, Alhmid I, AlOlama F, Mazahir F. Evaluating the Mentzer Index for Screening of Iron Deficiency Anemia and Beta Thalassemia Among Infants Visiting Primary Health Centers in Dubai, United Arab Emirates: A Retrospective Study. Cureus 2024; 16:e66286. [PMID: 39238747 PMCID: PMC11375987 DOI: 10.7759/cureus.66286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE The study aims to apply the Mentzer index to the population of all eligible pediatric patients presenting to primary healthcare centers (PHCs) in Dubai for the first year of life screening. Additionally, the study will estimate the prevalence of iron deficiency anemia (IDA) and β-thalassemia in children presenting to the PHCs and evaluate the importance of PHCs in screening children for IDA and β-thalassemia by comparing the results of this study to previous results. METHODS The SALAMA system (electronic medical record system used in PHCs in Dubai) was used for collecting the data. Eligible patients' data, such as hemoglobin, mean corpuscular volume (MCV), and red blood cell (RBC) counts were collected and recorded. The Mentzer index was applied to patients and the index results were compared to the gold standard results extracted from the SALAMA system. The gold standard diagnosis for IDA used was the serum ferritin test and the gold standard diagnosis for β-thalassemia used in the study was hemoglobin electrophoresis. RESULTS Out of the 75 eligible patients with low hemoglobin, 11 (14.6%) had low ferritin indicating IDA. Moreover, eight (10.6%) patients had abnormal hemoglobin electrophoresis indicating β-thalassemia. The Mentzer index was applied to the patients; 13 (17.3%) of them had a value less than 13 (β-thalassemia) and 6 (8%) had a value more than 13 (IDA). The sensitivity of the Menzter index in screening IDA and β-thalassemia is 99% and the specificity is 54.5%. CONCLUSION Our study found that the Mentzer's index is a reliable screening tool due to its high sensitivity; however, we suggest replicating the study with a larger sample size to get more clinically significant results.
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Affiliation(s)
- Alya Alkamali
- Pediatrics, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Latifa S Alshafiei
- Pediatrics, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Maryam AlJasmi
- Pediatrics, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Hadi Helali
- Pediatrics, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | | | | | - Fatima Mazahir
- Pediatrics, Al Jalila Children's Speciality Hospital, Dubai, ARE
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Chaouch L, Moumni I, Ben Abdallah J, Bouchahda R, Methlouthi J, Mahdhaoui N, Matamri W, Braham N, Bouguila F, Mejri L, Charefeddine B, Chaieb A, Khairi H, Menif S. New Born Screening of Hemoglobinopathies in a Center Tunisian Population. J Pediatr Hematol Oncol 2024; 46:e296-e299. [PMID: 38748601 DOI: 10.1097/mph.0000000000002864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/15/2024] [Indexed: 06/25/2024]
Abstract
Sickle cell diseases, β-thalassemia, and other hemoglobinopathies are common in Africa. Their distribution differs from one region to another. There are higher frequencies in Western and Northern Africa. Their clinical complications presented a real public health problem in each country. For this, early treatment can improve the severity of these diseases. Hemoglobinopathies targeted by screening are associated with SCD, β, and α thalassemia. Our study aim is to report our experience with newborn screening for hemoglobinopathy in Tunis. The 156 newborn's cord blood was collected at the time of childbirth in the center region (Farhat Hached Hôspital). We opted for hemoglobin exploration to achieve maximum efficiency and effectiveness in screening. After that, all patients suspected to have hemoglobinopathies are affected by molecular investigation. Our findings showed the presence of some hemoglobinopathies such as β-thalassemia and α-thalassemia with the following frequencies: 12% and 0.33%. The molecular results show the presence of HBB: c.93-21G>A, IVS-I-110G>A, HBBc. -106G>A -56G>C, HBBc.404T>C, Hb Yaounde described for the first time in Tunisia and α 3,7 . In conclusion, newborn screening diagnoses neonates with different examples of hemoglobinopathies, which will be beneficial not only for the care of the child but also for genetic counseling of the potential risk's parents.
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Affiliation(s)
- Leila Chaouch
- Laboratoire d'hématologie moléculaire et cellulaire, Université de Tunis El Manar, Institut Pasteur de Tunis
- Laboratoire de Biochimie, Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie
| | - Imen Moumni
- Laboratoire d'hématologie moléculaire et cellulaire, Université de Tunis El Manar, Institut Pasteur de Tunis
| | - Jihene Ben Abdallah
- Laboratoire de Biochimie, Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie
| | - Rim Bouchahda
- Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie, centre de maternité
| | - Jihene Methlouthi
- Neonatology Department, Farhat Hached Hospital, University of Sousse, Faculty of Medicine of Sousse, Tunisia
| | - Nabiha Mahdhaoui
- Neonatology Department, Farhat Hached Hospital, University of Sousse, Faculty of Medicine of Sousse, Tunisia
| | - Wided Matamri
- Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie, service d'hématologie, Tunisia
| | - Najia Braham
- Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie, service d'hématologie, Tunisia
| | - Fatma Bouguila
- Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie, centre de maternité
| | - Lina Mejri
- Laboratoire d'hématologie moléculaire et cellulaire, Université de Tunis El Manar, Institut Pasteur de Tunis
| | - Bassem Charefeddine
- Laboratoire de Biochimie, Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie
| | - Anouar Chaieb
- Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie, centre de maternité
| | - Hedi Khairi
- Hôpital Farhat Hached, Université de Sousse, Faculté de Médecine de Sousse, Tunisie, centre de maternité
| | - Samia Menif
- Laboratoire d'hématologie moléculaire et cellulaire, Université de Tunis El Manar, Institut Pasteur de Tunis
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Khoshnaw NSH, Omar JJ, Hussein ZS, Mohammed RN. Premarital Screening is Pivotal in Reducing the Births of Babies Affected with Thalassemia Major in Iraq. Hemoglobin 2024; 48:56-59. [PMID: 38565325 DOI: 10.1080/03630269.2024.2325456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
Thalassemia major is one of the health problems in Iraq, especially in Kurdistan. Pre-marriage mandatory preventive screening program was established in Kurdistan in 2008, which allowed us to study the prevalence of different hemoglobinopathies among newly married young adults in this region. A total of 1154 subjects (577 couples) attending the Koya district, premarital Health center, were screened using red cell indices. Those who had mean corpuscular volume (MCV)<80 fl and mean corpuscular hemoglobin (MCH)<27 pg had high-performance liquid chromatography and iron studies. Out of 1154 individuals that were evaluated, 183 (11.9%) had low MCV and MCH. Of the former 183 subjects, 69 (5.97%) had β-thalassemia trait, 10 (0.86%) had δβ-thalassemia trait, and no other hemoglobinopathies were recorded in our study. There was second-degree consanguinity in 4.7% of all 577 couples. In two couples, both partners had β-thalassemia trait and both were consanguineous. Both couples decided to separate after counseling. Based on the current study, the role of the premarital screening program in decreasing the number of new thalassemia major cases among the Kurdish population is laudable. Therefore, mandatory premarital screening is advised in all parts of Iraq.
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Affiliation(s)
- Najmaddin S H Khoshnaw
- Department of Clinical Science, College of Medicine, University of Sulaimani, Sulaymaniyah, Iraq
- Department of Medical Laboratory Science, Komar University of Science and Technology, Ministry of Higher Education, Sulaymaniyah, Iraq
| | - Jawhar J Omar
- Department of Hematology, Shahid Dr. Khalid Teaching Hospital, Koya General Health Directorate, Erbil, Iraq
| | - Zahir S Hussein
- Department of Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Rebar N Mohammed
- Medical Laboratory Analysis Department, College of Health Sciences, Cihan University Sulaimaniya, Sulaymaniyah, Iraq
- Department of Microbiology, College of Veterinary Medicine, University of Sulaimani, Sulaymaniyah, Iraq
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El-Beshlawy A, Dewedar H, Hindawi S, Alkindi S, Tantawy AA, Yassin MA, Taher AT. Management of transfusion-dependent β-thalassemia (TDT): Expert insights and practical overview from the Middle East. Blood Rev 2024; 63:101138. [PMID: 37867006 DOI: 10.1016/j.blre.2023.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
β-Thalassemia is one of the most common monogenetic diseases worldwide, with a particularly high prevalence in the Middle East region. As such, we have developed long-standing experience with disease management and devising solutions to address challenges attributed to resource limitations. The region has also participated in the majority of clinical trials and development programs of iron chelators and more novel ineffective erythropoiesis-targeted therapy. In this review, we provide a practical overview of management for patients with transfusion-dependent β-thalassemia, primarily driven by such experiences, with the aim of transferring knowledge to colleagues in other regions facing similar challenges.
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Affiliation(s)
- Amal El-Beshlawy
- Department of Pediatric Hematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Dewedar
- Thalassemia Center, Latifa Hospital, Dubai, United Arab Emirates
| | - Salwa Hindawi
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salam Alkindi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Azza A Tantawy
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed A Yassin
- Department of Hematology and Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Murad H, Moassas F, Ali B, Katranji E, Mukhalalaty Y. The Spectrum of α-Thalassemia Mutations in Syrian Patients. Hemoglobin 2023; 47:245-248. [PMID: 38146675 DOI: 10.1080/03630269.2023.2296927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
α-Thalassemia (α-thal) is a globally prevalent genetic disorder of hemoglobin (Hb) structure where the rate of α-globin chain synthesis is reduced or absent due to the presence of α-globin mutation(s). The aim of this study is to define the spectrum of α-globin gene mutations and evaluate their allele frequency in a group of α-thal carriers. A total of 55 individuals with possible α-thal patients were referred from the thalassemia centers in Syria. They have unexplained hypochromia and microcytosis. All patients were genetically tested for 21 common α-globin gene mutations using reverse hybridization kit. Seven different α-globin gene mutations and 13 different genotypes were detected in 55 patients. The two most frequently encountered mutations were -α3.7 deletion (47.1%) and --MED mutation (21.4%). The most commonly observed genotype was -α3.7/αα (40%), followed by --MED/αα genotype (21.8%). We determined the most common α thalassemia mutations in the Syrian patients. α-Thalassemia mutations with deletions were mostly observed in our study.
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Affiliation(s)
- Hossam Murad
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
| | - Faten Moassas
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
| | - Bouthina Ali
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
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Touma H, Youssef LA, Al-Salhi L, Ismail Al-khalil W, AlKeba K. Prevalence and Management of Transfusional Iron Overload in Syrian Beta Thalassemia Major Patients Pre and during the Syrian Conflict. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8911518. [PMID: 37743972 PMCID: PMC10513871 DOI: 10.1155/2023/8911518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/16/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023]
Abstract
Objectives The primary aim of this study was to evaluate the prevalence of iron overload and the real-world clinical effectiveness of the iron chelation therapies (ICTs) in Syrian patients with transfusion-dependent beta thalassemia major (BTM) prior to and during the ongoing Syrian conflict. Methods This single-center, two-stage observational study was conducted at Homs National Thalassemia Center (HNTC) prior to (2009) and during (2019) the armed conflict. The prevalence and the severity of iron overload, as well as the effectiveness of four iron chelation regimens, were assessed using serum ferritin (SF) concentrations as a means of monitoring in two cohorts of BTM patients receiving deferoxamine (DFO), deferiprone (DFP), deferasirox (DFX), or a combination of DFO and DFP therapy in both years. Statistical analyses encompassed one-way ANOVA, Kruskal-Wallis, Mann-Whitney U, and chi-square (χ2) tests for the comparisons of the variables and the frequencies between the two cohorts and subgroups. Results We included all eligible BTM patients at HNTC in 2009 (n = 205) and 2019 (n = 172). Only 84 patients from the 2009 cohort were accessible in 2019. Our findings revealed that 98% and 89% of the patients had iron overload (SF ≥ 1500 ng/mL) and comparable elevated median SF concentrations (3868 and 3757 ng/mL) in 2009 and 2019, respectively (P = 0.275). Furthermore, patients on DFO demonstrated the poorest control of iron overload and the highest SF concentrations (4319 and 5586 ng/mL), whereas those on DFX achieved superior outcomes and the lowest SF concentrations (3355 and 2152 ng/mL) in both years. Twenty-six patients from the 2019 cohort received no ICT for six years (from 2012 to 2018) and experienced extremely severe iron overload with SF levels ranging between 4481 and 16,000 ng/mL. Conclusions Our findings prove a high prevalence of iron overload and suboptimal chelation outcomes in Syrian BTM patients, both prior to and during the ongoing armed conflict, despite the provision of free ICTs at HNTC. Poor adherence and older age of patients may explain the unfavorable outcomes of DFO and (DFO+DFP) regimens, whereas younger age and higher socioeconomic status may have contributed to the lowest SF and superior outcomes in patients on DFX. This study also demonstrates the crucial role of the National Thalassemia Centers, namely HNTC, in providing health services to BTM patients in times of peace and conflict.
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Affiliation(s)
- Hanan Touma
- Program of Clinical and Hospital Pharmacy, Department of Pharmaceutics & Pharmaceutical Technology, Faculty of Pharmacy, Damascus University, Damascus, Syria
- University of Kalamoon, Deir Atiyah, Damascus, Syria
| | - Lama A. Youssef
- Program of Clinical and Hospital Pharmacy, Department of Pharmaceutics & Pharmaceutical Technology, Faculty of Pharmacy, Damascus University, Damascus, Syria
| | - Lana Al-Salhi
- Program of Clinical and Hospital Pharmacy, Department of Pharmaceutics & Pharmaceutical Technology, Faculty of Pharmacy, Damascus University, Damascus, Syria
| | - Wouroud Ismail Al-khalil
- Program of Clinical and Hospital Pharmacy, Department of Pharmaceutics & Pharmaceutical Technology, Faculty of Pharmacy, Damascus University, Damascus, Syria
| | - Khawla AlKeba
- National Thalassemia Center, Homs, Syria
- Al-Ahli Hospital, Homs, Syria
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9
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Almomani AA, Shraim AS, Atoom AM, Abdel MBA, Alhmoud JF. Evaluation of the validity of the pre-marriage mean corpuscular volume value as a predictive test for b-thalassemia carrier status. J Med Biochem 2023; 42:195-205. [PMID: 36987417 PMCID: PMC10040200 DOI: 10.5937/jomb0-37682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/30/2022] [Indexed: 11/02/2022] Open
Abstract
Background The national mandatory premarital screening test is based on mean corpuscular volume (MCV) > 80 fL value for the detection of β-thalassemia to provide acceptance for marriage. The objective of this study is to assess the efficacy of MCV as a screening test for β-thalassemia trait in the present population. Methods This study was conducted on 418 blood samples collected from adult individuals. The diagnosis of β-thalassemia carrier was given to those having HbA2 values equal to or above 3.5%. The diagnostic reliability of different RBC indices and formulas in discriminating cases of β-thalassemia trait were evaluated. Finally, a new index called "Momani" was determined based on MCV, RDW and RBC count. Results β-thalassemia trait was identified in 10% of the cases. The measured MCV value was significantly lower in β-thalassemia carrier group compared to non-carrier group (p = <0.001). MCV value and RBC count showed a higher diagnostic reliability than other RBC indices. We found that MCV ≤ 74.45 fL is more suitable cutoff value of MCV with 86.2% specificity, 71.4% sensitivity, 36.6% positive predictive value, and 96.4% negative predictive value. Finally, our index "Momani" was found to be useful in predicting carrier and paralleled the performance of Sirdah, Mentzer, and Ehsani indices. Conclusions MCV<80 is a useful but not a perfect cutoff point for the screening of β-thalassemia carriers from noncarriers. The diagnostic accuracy of MCV can be improved by selecting a new cutoff value. Moreover, "Momani" index shows good discrimination ability in diagnosing β-thalassemia carrier in our population.
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Affiliation(s)
- Ali A. Almomani
- Al-Ahliyya Amman University, Pharmacological and Diagnostic Research Centre, Amman, Jordan
| | - Ala'a S. Shraim
- Al-Ahliyya Amman University, Faculty of Allied Medical Sciences, Department of Medical Laboratory Sciences, Amman, Jordan
| | - Ali M. Atoom
- Al-Ahliyya Amman University, Pharmacological and Diagnostic Research Centre, Amman, Jordan
| | - Majeed Bayan A. Abdel
- Al-Ahliyya Amman University, Pharmacological and Diagnostic Research Centre, Amman, Jordan
| | - Jehad F. Alhmoud
- Al-Ahliyya Amman University, Pharmacological and Diagnostic Research Centre, Amman, Jordan
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MacVinish S, van Leeuwen C, Hoetjes M, Aoki Y, Foley D, Roggeveen H. Lessons identified from initiating a thalassaemia programme in a conflict setting: a case study from northeast Syria. Confl Health 2023; 17:5. [PMID: 36750900 PMCID: PMC9903447 DOI: 10.1186/s13031-023-00503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Thalassaemia affects many families in Northeast Syria, an area devastated by over a decade of conflict which has significantly impacted their health system. People with thalassaemia require holistic multidisciplinary care for the clinical complications of thalassaemia. The risks of thalassaemia treatment include blood-borne viral infections secondary to unsafe transfusion, increased vulnerability to serious bacterial infection following splenectomy, and complications of both iron overload and iron chelation therapy. Médecins Sans Frontières (MSF) provided outpatient thalassaemia care programmes in northeast Syria between April 2017 October 2019 in a complex conflict context challenged by population displacement, the destruction of medical facilities, and periods of insecurity. METHODS We performed a secondary descriptive analysis of the thalassaemia cohort data to describe basic clinical and demographic characteristics of the patient population. A desk review of internal and publicly available documents was supplemented by informal interviews with MSF staff to describe and analyse the programmatic approach. CASE DESCRIPTION MSF delivered programmes with thalassaemia investigations, provision of blood transfusion, iron chelation therapy, and psychosocial support. Thalassemia programmes were novel for the organisation and operational learning took place alongside service implementation. Lessons were identified on equipment procurement and the requirements for the implementation of vital investigations (including ferritin testing), to inform clinical decision making. Lessons included the importance of supply planning for sufficient blood products to meet diverse clinical needs in a conflict area, so those with thalassaemia have continued access to blood products among the competing priorities. Iron chelation therapy met a large need in this cohort. Adapted protocols were implemented to balance social factors, hygiene considerations, toxicity, tolerability, and adherence to therapy. Wider service needs included considerations for family planning advice and services, continuity of care and patient access through decentralised services or laboratory access, psychosocial support, and improved data collection including quality of life measurements to understand the full impact of such programmes. CONCLUSIONS Although this type of programming was not "routine" for the organisation, MSF demonstrated that life-sustaining thalassaemia care can be provided in complex conflict settings. International non-governmental organisations can consider this care possible in similar contexts.
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Affiliation(s)
- Sally MacVinish
- grid.452780.cMédecins Sans Frontières, Amsterdam, The Netherlands
| | | | - Maartje Hoetjes
- grid.452780.cMédecins Sans Frontières, Amsterdam, The Netherlands
| | - Yoshihiro Aoki
- grid.174567.60000 0000 8902 2273School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Deirdre Foley
- grid.417322.10000 0004 0516 3853Department of Paediatric Infectious Disease, Children’s Health Ireland at Crumlin, Dublin, Ireland
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Mohammed EI, Elmosaad YM, Waggiallah HA. Hemoglobinopathy Patterns in Anemic Patients with a Strong History of Sickle Cell Disease in Eastern Province, Saudi Arabia: A Cross-Sectional Study. Pak J Biol Sci 2022; 25:1094-1099. [PMID: 36978277 DOI: 10.3923/pjbs.2022.1094.1099] [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: 03/06/2023]
Abstract
<b>Background and Objective:</b> The most common genetic disease in humans is hemoglobinopathies, also known as hemoglobin hereditary diseases. The purpose of this study was to look at the hemoglobinopathy patterns in anemic patients with a history of sickle cell disease in Saudi Arabia's Eastern Province. <b>Materials and Methods:</b> This prospective cross-sectional study was conducted on anemic patients attending the hospital with a strong family history of hemoglobinopathy and general signs and symptoms, as well as mild to moderate anemia crises. One hundred and ten people were chosen to participate in this study. The research was carried out between September, 2019 and October, 2020. <b>Results:</b> The sickle cell trait was the most common hemoglobinopathy in males (31.1%) and sickle cell trait+beta thalassemia minor was the most common in females (18%). The gender of patients and the distribution of hemoglobinopathy types were found to have a significant relationship (p-value of 0.001). <b>Conclusion:</b> A significant correlation was discovered between the gender of patients and the distribution of hemoglobinopathy types. More efforts must be made to raise the prevention of endogamy awareness among Saudis.
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Abu-Shaheen A, Dahan D, Henaa H, Nofal A, Abdelmoety DA, Riaz M, AlSheef M, Almatary A, AlFayyad I. Sickle cell disease in Gulf Cooperation Council countries: a systematic review. Expert Rev Hematol 2022; 15:893-909. [PMID: 36217841 DOI: 10.1080/17474086.2022.2132225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Evidence related to the national burden of Sickle Cell Disease (SCD) in Gulf Cooperation Council (GCC) largely fragmented. Thus, the aim of this study is to systemically review studies from GCC countries to assess the epidemiological profile of SCD. AREAS COVERED We searched combinations of key terms in MEDLINE/PubMed, CINAHL, and EMBASE. We selected relevant observational studies reporting the frequency, incidence, prevalence, risk factors, mortality rate, and complications of SCD among the GCC population. Studies restricted to laboratory diagnostic tests, experimental and animal studies, review articles, case reports and series, and conference proceedings and editorials were excluded. A total of 1,347 articles were retrieved, out of which 98 articles were found to be eligible and included in the study. The total number of participants from all the included studies was 3496447. The prevalence of SCD ranged from 0.24%-5.8% across the GCC and from 1.02%-45.8% for the sickle cell trait. Consanguineous marriage was a risk factor for likely giving children affected with hemoglobinopathies. EXPERT OPINION The prevalence of SCD and its complications vary among GCC. Because of the high prevalence of SCD and its complications, health authorities should focus on more rigorous prevention and treatment strategies.
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Affiliation(s)
| | - Doaa Dahan
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Humariya Henaa
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Nofal
- Emergency Medicine Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Doaa A Abdelmoety
- Clinical Research Holy Management Department, Executive Administration of Research, King Abdullah Medical City in Capital, Makkah, Saudi Arabia
| | - Muhammad Riaz
- Department of Statistics, University of Malakand, Pakistan
| | - Mohammed AlSheef
- Internal Medicine Consultant, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Almatary
- Neonatal Intensive Care Unit, King Fahad Medical City, Children specialized hospital. Riyadh, Saudi Arabia
| | - Isamme AlFayyad
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Macharia AW, Mochamah G, Makale J, Howard T, Mturi N, Olupot-Olupot P, Färnert A, Ware RE, Williams TN. Case Report: β-thalassemia major on the East African coast. Wellcome Open Res 2022; 7:188. [PMID: 37811313 PMCID: PMC10551670 DOI: 10.12688/wellcomeopenres.17907.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 10/10/2023] Open
Abstract
Background: β-thalassemia is rare in sub-Saharan Africa and to our knowledge there has been no case of homozygous β-thalassemia major reported from this region. In a recent cohort study, we identified four β-thalassemia mutations among 83 heterozygous carriers in Kilifi, Kenya. One of the mutations identified was a rare β-globin gene initiation codon mutation (ATG➝ACG) (rs33941849). Here we present a patient with β-thalassemia major resulting from this mutation, only the second homozygous patient to have been reported. Methods: The female patient presented to Kilifi County Hospital aged two years with a one week left sided abdominal swelling. Clinical, hematological and genetic information were collected at admission and follow-up. Results: Admission bloods revealed marked anemia, with a hemoglobin (Hb) value of 6.6 g/dL and a low mean corpuscular volume of 64 fL. High performance liquid chromatography (HPLC) revealed the absence of HbA0 and elevated levels of HbF, suggesting a diagnosis of β-thalassemia major. Sequencing revealed that the child was homozygous for the rs33941849 initiation codon mutation. Conclusions: We hope that this study will create awareness regarding the presence of β-thalassemia as a potential public health problem in the East Africa region and will prompt the development of local guidelines regarding the diagnosis and management of this condition.
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Affiliation(s)
- Alexander W. Macharia
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
| | - George Mochamah
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
| | - Johnstone Makale
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
| | - Thad Howard
- Division of Hematology, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Neema Mturi
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
| | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale, Uganda
- Busitema University Faculty of Health Sciences, Mbale, Uganda
| | | | - Russell E. Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Thomas N. Williams
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
- Institute for Global Health Innovation, Imperial College, London, UK
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Belmokhtar I, Lhousni S, Elidrissi Errahhali M, Ghanam A, Elidrissi Errahhali M, Sidqi Z, Ouarzane M, Charif M, Bellaoui M, Boulouiz R, Benajiba N. Molecular heterogeneity of β-thalassemia variants in the Eastern region of Morocco. Mol Genet Genomic Med 2022; 10:e1970. [PMID: 35615994 PMCID: PMC9356555 DOI: 10.1002/mgg3.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/22/2022] [Accepted: 05/09/2022] [Indexed: 11/09/2022] Open
Abstract
Background β‐thalassemia syndromes are the most common hereditary blood disorders in the world and are recognized as a major health problem in Morocco. They are characterized by the reduction or the absence of β‐globin chain synthesis. The severity of the disease depends on the nature of the variants affecting the β‐globin gene (HBB), and each ethnic group has its own mutation spectrum. Hereby, we present, for the first time, the molecular profile of β‐thalassemia in the Eastern region of Morocco. Methods This study concerns 39 cases from 33 families who were enrolled in the BRO Biobank. Nineteen were diagnosed with β‐thalassemia major and 20 with β‐thalassemia minor. To detect mutations of the β‐globin gene, we have used RFLP‐PCR and Sanger sequencing. Results Nine known β‐thalassemia variants have been identified. Among these, we reported, for the first time in the Moroccan population, the Czechoslovakian variant C38/39(‐C) at homozygous state. The C39(C > T) was the most frequent variant (72.54%), followed by FSC5(‐CT) (5.88%), FSC6(−A), IVS‐1‐110(G > A), −29(A > G), C38/39(‐C) (3.92% each), and finally by IVS‐I‐1(G > A), IVS‐II‐1(G > A), and −56(G > C) (1.96%). Of particular interest this mutational spectrum of β‐thalassemia is very different from that found in previous studies in Morocco or in other North African countries. Conclusion This study is the first contribution to the description of the molecular profile of β‐thalassemia in the Eastern region of Morocco. It shows the high molecular heterogeneity of β‐thalassemia in our country. Therefore, these results can be valuable for the implementation of carrier screening, genetic counseling, and prenatal diagnosis programs.
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Affiliation(s)
- Ihab Belmokhtar
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Saida Lhousni
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Mounia Elidrissi Errahhali
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Ayad Ghanam
- Department of PediatricsMohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed PremierOujdaMorocco
| | - Manal Elidrissi Errahhali
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | | | - Meryem Ouarzane
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Majida Charif
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Mohammed Bellaoui
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Redouane Boulouiz
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and PharmacyUniversity Mohammed PremierOujdaMorocco
| | - Noufissa Benajiba
- Department of PediatricsMohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed PremierOujdaMorocco
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Zahran MM, Elshreif AM, Abou-Eladab E, Altawel AA. A Cross-sectional Study of Iron Deficiency Anemia and Hemoglobinopathy Carriers among School Children in Two Different Cities in KSA. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Iron deficiency anemia (IDA) is the most common cause of anemia in the Kingdom of Saudi Arabia. Thalassemia and sickle cell disease (SCD) are major concerns in several nations, including KSA. This study sought to investigate the prevalence of IDA, sickle cell trait (SCT), and B thalassemia trait (BTT) among school children in Al-Khobar and Makkah, Saudi Arabia.
Methods: A multistage random sample of 570 school children aged 12–18 years from both cities were educated about these illnesses and tested for CBC, serum iron, TIBC, reticulocytosis, and sickling. In some circumstances, hemoglobin electrophoresis and HPLC were used.
Results: Overall, 13% of people had IDA, 3.2 percent had SCT, and 2.5 percent had BTT. The hematological parameters of students with IDA and BTT differed significantly from those of normal students in each city, but not between normal students and those with SCT. There were no significant differences between the sexes for all blood parameters except iron and TIBC.
Conclusion: Strengthening public health education, dietary initiatives, and school-based hemoglobinopathy carrier screening is proposed to help detect anemia early.
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Halim-Fikri BH, Lederer CW, Baig AA, Mat-Ghani SNA, Syed-Hassan SNRK, Yusof W, Abdul Rashid D, Azman NF, Fucharoen S, Panigoro R, Silao CLT, Viprakasit V, Jalil N, Mohd Yasin N, Bahar R, Selvaratnam V, Mohamad N, Nik Hassan NN, Esa E, Krause A, Robinson H, Hasler J, Stephanou C, Raja-Sabudin RZA, Elion J, El-Kamah G, Coviello D, Yusoff N, Abdul Latiff Z, Arnold C, Burn J, Kountouris P, Kleanthous M, Ramesar R, Zilfalil BA. Global Globin Network Consensus Paper: Classification and Stratified Roadmaps for Improved Thalassaemia Care and Prevention in 32 Countries. J Pers Med 2022; 12:jpm12040552. [PMID: 35455667 PMCID: PMC9032232 DOI: 10.3390/jpm12040552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
The Global Globin Network (GGN) is a project-wide initiative of the Human Variome/Global Variome Project (HVP) focusing on haemoglobinopathies to build the capacity for genomic diagnosis, clinical services, and research in low- and middle-income countries. At present, there is no framework to evaluate the improvement of care, treatment, and prevention of thalassaemia and other haemoglobinopathies globally, despite thalassaemia being one of the most common monogenic diseases worldwide. Here, we propose a universally applicable system for evaluating and grouping countries based on qualitative indicators according to the quality of care, treatment, and prevention of haemoglobinopathies. We also apply this system to GGN countries as proof of principle. To this end, qualitative indicators were extracted from the IthaMaps database of the ITHANET portal, which allowed four groups of countries (A, B, C, and D) to be defined based on major qualitative indicators, supported by minor qualitative indicators for countries with limited resource settings and by the overall haemoglobinopathy carrier frequency for the target countries of immigration. The proposed rubrics and accumulative scores will help analyse the performance and improvement of care, treatment, and prevention of haemoglobinopathies in the GGN and beyond. Our proposed criteria complement future data collection from GGN countries to help monitor the quality of services for haemoglobinopathies, provide ongoing estimates for services and epidemiology in GGN countries, and note the contribution of the GGN to a local and global reduction of disease burden.
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Affiliation(s)
- Bin Hashim Halim-Fikri
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Carsten W. Lederer
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Atif Amin Baig
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu 20400, Terengganu, Malaysia;
| | - Siti Nor Assyuhada Mat-Ghani
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (S.N.A.M.-G.); (N.N.N.H.)
| | - Sharifah-Nany Rahayu-Karmilla Syed-Hassan
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Wardah Yusof
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Diana Abdul Rashid
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Nurul Fatihah Azman
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Suthat Fucharoen
- Thalassemia Research Centre, Institute of Molecular Biosciences, Mahidol University, Nakhom Pathom 73170, Thailand;
| | - Ramdan Panigoro
- Department of Biomedical Sciences, Medical Genetics Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
| | - Catherine Lynn T. Silao
- Institute of Human Genetics, National Institutes of Health, University of the Philippines, Manila 1000, Philippines;
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila 1000, Philippines
| | - Vip Viprakasit
- Department of Paediatrics & Thalassaemia Centre, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Norunaluwar Jalil
- UKM Specialist Children’s Hospital, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Norafiza Mohd Yasin
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Institutes of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.M.Y.); (E.E.)
| | - Rosnah Bahar
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Veena Selvaratnam
- Hospital Ampang, Jalan Mewah Utara, Taman Pandan Mewah, Ampang Jaya 68000, Selangor, Malaysia;
| | - Norsarwany Mohamad
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Nik Norliza Nik Hassan
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (S.N.A.M.-G.); (N.N.N.H.)
| | - Ezalia Esa
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Institutes of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.M.Y.); (E.E.)
| | - Amanda Krause
- Division of Human Genetics, National Health Laboratory Service (NHLS) and School of Pathology, Faculty of Health Sciences, The University of the Witwatersrand, Watkins Pitchford Building, NHLS Braamfontein, Cnr Hospital and De Korte St, Hillbrow, P.O. Box 1038, Johannesburg 2000, South Africa;
| | - Helen Robinson
- Nossal Institute for Global Health, MDDHS, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Julia Hasler
- Global Variome, Institute of Genetic Medicine, International Centre for Life, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK;
| | - Coralea Stephanou
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Raja-Zahratul-Azma Raja-Sabudin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Jacques Elion
- Medical School, Université Paris Diderot, 75018 Paris, France;
| | - Ghada El-Kamah
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo 12622, Egypt;
| | - Domenico Coviello
- Laboratorio di Genetica Umana, IRCCS Istituto Giannina Gaslini, Largo Gerolamo Gaslini 5, 16147 Genova, Italy;
| | - Narazah Yusoff
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas 13200, Pulau Pinang, Malaysia;
| | - Zarina Abdul Latiff
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Chris Arnold
- BioGrid Australia, Hodgson Associates, 4 Hodgson St., Kew, Melbourne, VIC 3101, Australia;
| | - John Burn
- Translational and Clinical Research Institute, International Centre for Life Times Square, Newcastle upon Tyne NE1 3BZ, UK;
| | - Petros Kountouris
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Marina Kleanthous
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Raj Ramesar
- Department of Pathology, University of Cape Town City of Cape Town, Cape Town 7925, South Africa;
| | - Bin Alwi Zilfalil
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: or ; Tel.: +60-9767-6531
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Khamees M, Wadaha H, Meshay H. Changes in coagulation status in patients with β-thalassemia in Iraq: A case-control study. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Atroshi SD, Al-Allawi NAS, Eissa AA. Updated Molecular Spectrum of β-Thalassemia Mutations in Duhok Province, Northern Iraq: Ethnic Variation and the Impact of Immigration. Hemoglobin 2021; 45:239-244. [PMID: 34794358 DOI: 10.1080/03630269.2021.1984250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Immigration impact on genetic epidemiology of thalassemia worldwide is well-recognized. Over the past decade, the Duhok Province of Northern Iraq attracted a large number of immigrants. To assess whether immigration had contributed to changes in the mutation spectrum of β-thalassemia (β-thal) in the region, we recruited 218 registered patients with symptomatic β-thal. The recruited patients included 50 (22.9%) from resettled migrant families. A total of 431 β-thal alleles were fully characterized, with 20 different thalassemia mutations, the most frequent being IVS-II-1 (G>A) (HBB: c.315 + 1G>A), IVS-I-6 (T>C) (HBB: c.92 + 6T>C), codon 5 (-CT) (HBB: c.17_18delCT), IVS-I-110 (G>A) (HBB: c.93-21G>A), codon 44 (-C) (HBB: c.135delC), codon 8 (-AA) (HBB: c.25_26delAA) and IVS-I-1 (G>A) (HBB: c.92 + 1G>A) constituting 72.8% of the total. Some differences in mutation spectrum were observed compared to earlier studies from this same province, the most notable of which were the higher frequencies of IVS-I-110 and codon 8. Interestingly, the highest proportions of alleles related to immigrants were encountered in these two allele groups. Ethnic variation was also documented, so that while Muslim Kurds had IVS-II-1, IVS-I-6, IVS-I-110, codon 5 and codon 44 as their most frequent mutations, the most frequent among Kurdish Yazidis, were codon 5, codon 44, codon 8 and IVS-I-6. These ethnic variations and changes in mutation spectrums are important and should be taken in consideration to ensure effective implementation of the thalassemia preventive program.
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Affiliation(s)
- Sulav D Atroshi
- Department of Hematology, Azadi Teaching Hospital, Duhok, Iraq.,Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
| | - Nasir A S Al-Allawi
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
| | - Adil A Eissa
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
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Shafique F, Ali S, Almansouri T, Van Eeden F, Shafi N, Khalid M, Khawaja S, Andleeb S, Hassan MU. Thalassemia, a human blood disorder. BRAZ J BIOL 2021; 83:e246062. [PMID: 34495151 DOI: 10.1590/1519-6984.246062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/02/2021] [Indexed: 11/22/2022] Open
Abstract
A group of inherited blood defects is known as Thalassemia is among the world's most prevalent hemoglobinopathies. Thalassemias are of two types such as Alpha and Beta Thalassemia. The cause of these defects is gene mutations leading to low levels and/or malfunctioning α and β globin proteins, respectively. In some cases, one of these proteins may be completely absent. α and β globin chains form a globin fold or pocket for heme (Fe++) attachment to carry oxygen. Genes for alpha and beta-globin proteins are present in the form of a cluster on chromosome 16 and 11, respectively. Different globin genes are used at different stages in the life course. During embryonic and fetal developmental stages, γ globin proteins partner with α globin and are later replaced by β globin protein. Globin chain imbalances result in hemolysis and impede erythropoiesis. Individuals showing mild symptoms include carriers of alpha thalassemia or the people bearing alpha or beta-thalassemia trait. Alpha thalassemia causes conditions like hemolytic anemia or fatal hydrops fetalis depending upon the severity of the disease. Beta thalassemia major results in hemolytic anemia, growth retardation, and skeletal aberrations in early childhood. Children affected by this disorder need regular blood transfusions throughout their lives. Patients that depend on blood transfusion usually develop iron overload that causes other complications in the body systems like renal or hepatic impairment therefore, thalassemias are now categorized as a syndrome. The only cure for Thalassemias would be a bone marrow transplant, or gene therapy with currently no significant success rate. A thorough understanding of the molecular basis of this syndrome may provide novel insights and ideas for its treatment, as scientists have still been unable to find a permanent cure for this deadly disease after more than 87 years since it is first described in 1925.
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Affiliation(s)
- F Shafique
- University of Azad Jammu and Kashmir, Faculty of Science, Department of Zoology, Muzaffarabad, Pakistan.,University of Sheffield, Faculty of Science, Department of Biomedical Science, Sheffield, United Kingdom
| | - S Ali
- Government College University Lahore, Faculty of Science, Department of Zoology, Applied Entomology and Medical Toxicology Laboratory, Lahore, Pakistan
| | - T Almansouri
- University of Sheffield, Sheffield Institute for Translational Neuroscience - SITraN, Department of Neuroscience, Sheffield, United Kingdom.,King Abdulaziz University, Department of Applied Medical Science (Medical Laboratory), Jeddah, Saudi Arabia
| | - F Van Eeden
- University of Sheffield, Faculty of Science, Department of Biomedical Science, Sheffield, United Kingdom
| | - N Shafi
- University of Azad Jammu and Kashmir, Faculty of Science, Department of Zoology, Muzaffarabad, Pakistan
| | - M Khalid
- Women University of Azad Kashmir, Department of Biotechnology, Bagh, Azad Kashmir, Pakistan
| | - S Khawaja
- University of Azad Jammu and Kashmir, Department of Biotechnology, Muzaffarabad, Pakistan
| | - S Andleeb
- University of Azad Jammu and Kashmir, Faculty of Science, Department of Zoology, Muzaffarabad, Pakistan
| | - M Ul Hassan
- University of Sheffield, Faculty of Science, Department of Molecular Biology and Biotechnology, Sheffield, United Kingdom
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Hamad L, Kreidieh K, Hamdan MB, Nakouzi G, Yazbek S. Mapping the Diverse Genetic Disorders and Rare Diseases Among the Syrian Population: Implications on Refugee Health and Health Services in Host Countries. J Immigr Minor Health 2021; 22:1347-1367. [PMID: 32172498 DOI: 10.1007/s10903-020-00987-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this systematic review is to provide physicians and researchers with a comprehensive list of reported genetic disorders in patients of Syrian origin-those who have become part of the largest displaced population globally-and to highlight the need to consider migrant population-based risk for the development of genetic disease control and prevention programs. This review was performed based on the 2015 PRISMA and the international prospective register of systematic reviews. The present review reports on a total of 166 genetic disorders (only 128 reported on OMIM) identified in the Syrian population. Of these disorders, 27% are endocrine-, nutritional- and metabolic-related diseases. Second to metabolic disorders are congenital malformations, deformations and chromosomal abnormalities. Diseases of the blood and the blood-forming organs accounted for 13% of the total genetic disorders. The majority of the genetic disorders reported in Syrian patients followed an autosomal recessive mode of inheritance. These findings are a reflection of the high rates of consanguineous marriages that favor the increase in incidence of these diseases. From the diseases that followed an autosomal recessive mode of inheritance, 22% are reported to be only present in Syria and other regional countries. Twelve of these genetic diseases were identified to be strictly diagnosed in individuals of Syrian origin. The present systematic review highlights the need to develop programs that target genetic disorders affecting Syrian migrants in host countries. These programs would have potential financial and economic benefits, as well as a positive impact on the physical and mental health of members of the Syrian refugee community and those of their host societies. In turn, this would decrease the burden on the health systems in host countries.
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Affiliation(s)
- Lina Hamad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khalil Kreidieh
- Office of Faculty Affairs, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mirna Bou Hamdan
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Riad El Solh, P.O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Ghunwa Nakouzi
- Department of Clinical Pathology, Cleveland Clinic Hospital, Cleveland, OH, USA.
| | - Soha Yazbek
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Riad El Solh, P.O Box 11-0236, Beirut, 1107 2020, Lebanon.
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21
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Farra C, Abdouni L, Souaid M, Awwad J, Yazbeck N, Abboud M. The Spectrum of β-Thalassemia Mutations in the Population Migration in Lebanon: A 6-Year Retrospective Study. Hemoglobin 2021; 45:365-370. [PMID: 33947296 DOI: 10.1080/03630269.2021.1920975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
β-Thalassemia (β-thal) is highly prevalent among the Mediterranean populations. In Lebanon, the carrier rate of the disease is estimated to be around 2.0-3.0%. In this retrospective study, we determined the spectrum of β-thal mutations in a total of 170 individuals from a sample of 140 Lebanese, Iraqi and Syrian refugee families in Lebanon, over a period from 2012 to 2018. Twenty-eight different β-globin gene mutations were identified. The most prevalent mutations were IVS-I-110 (G>A) (HBB: c.93-21G>A), IVS-II-1 (G>A) (HBB: c.315+1G>A), IVS-I-6 (T>C) (HBB: c.92+6T>C) and IVS-I-1 (G>A) (HBB: c.92+1G>A), accounting for the majority of mutations found in HBB mutations analysed in 250 alleles. Ten different β-globin gene mutations that were not previously described in Lebanon were identified in our study. These mutations include the IVS-II-848 (C>A) (HBB: c.316-3C>A), codons 9/10 (+T) (HBB: c.30_31insT), codon 15 (-T) (HBB: c.46delT), -86 (C>G) (HBB: c.-136C>G), Cap +22 (G>A) (HBB: c.-29G>A), -28 (A>C) (HBB: c.-78A>C), codon 7 (GAG>TAG) (HBB: c.22G>T), codon 26 (GAG>TAG) (HBB: c.79G>T), codons 41/42 (-TTCT) (HBB: c.126_129delCTTT), and codons 82/83 (-G) (HBB: c.250delG). Of these, six mutations [codons 9/10, codon 15 (-T), -86, codon 7, codon 26, codons 82/83) were identified in Lebanese samples only; one mutation (IVS-II-848) was identified in both Lebanese and Iraqis; and three mutations (Cap +22, -28, codons 41/42) were identified in Iraqi samples only. Further studies will help better delineate the spectrum of β-thal mutations among different ethnic groups, and provide crucial prevention strategies.
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Affiliation(s)
- Chantal Farra
- Medical Genetics, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Abdouni
- Medical Genetics, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mirna Souaid
- Medical Genetics, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johnny Awwad
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine Yazbeck
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miguel Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Al-Eisawi Z, Jacoub K, Alsukker A. A large-scale study exploring understanding of the national premarital screening program among Jordanians: Is an at-risk marriage a valid option for Jordanians? PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2021; 30:319-330. [PMID: 33148133 DOI: 10.1177/0963662520968468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Detecting carrier couples through premarital screening implementation is an effective way of controlling thalassaemia. The aim of this study was to investigate the knowledge of university students towards premarital screening and their possible involvement in an at-risk marriage. Students (n = 976) were chosen randomly from Jordanian universities. The questionnaire consisted of three sections: socio-demographical data, the students' knowledge about the screening programme, and finally their beliefs and future decisions related to it. Most (90%) participants were aware of the premarital screening availability. Females had significantly better understanding of premarital screening compared to males. Despite the majority of the participants not wanting to go ahead with at-risk marriages, 23% would not be deterred from marrying their anticipated partner and believed engaging in at-risk marriage was a valid idea. We suggest providing more effective educational programmes, genetic counselling and free prenatal diagnosis for at-risk couples.
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Deeb A, Muammar T, Alsaffar H, Sedaghat S, Al Hassani N, Odeh R, Alkhayyat H, Al Sinani A, Attia N, Adhami S, Elbarbary N. Use of ambulatory glucose monitoring and analysis of ambulatory glucose profile in clinical practice for diabetes management; a position statement of the Arab Society of Paediatric Endocrinology and diabetes. Diabetes Res Clin Pract 2021; 173:108671. [PMID: 33493578 DOI: 10.1016/j.diabres.2021.108671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Diabetes mellitus imposes a significant burden around the world generally and in the Middle East and North Africa specifically. Glucose monitoring is a cornerstone of diabetes management. METHODS Glycated haemoglobin has always been the main metric for assessing glycaemic control, but its use is linked with multiple pitfalls. As an alternative, continuous glucose monitoring is becoming a standard of care in many countries. Intermittent scanning glucose monitoring (isCGM) has acquired a worldwide popularity and has been proven to improve glycaemic control, hypoglycaemia detection and prevention, and quality of life. RESULTS The most recent International Society of Paediatric and Adolescent Diabetes practice. guidelines recommended its use in young people with diabetes observing Ramadan to ensure safe fasting. At a meeting in Abu Dhabi in November 2019, the Arab Society for Paediatric. Endocrinology and Diabetes brought together a number of regional diabetes experts, patient. representatives and international expert advisors to review the evidence for isCGM and propose. guidelines for its use in the Middle East and North Africa region. CONCLUSION In this paper, the authors strongly recommend the use of isCGM for patients in MENA and present general recommendations and compressive specific guidance for physicians and patients, which they believe will also have wider resonance.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Tawfik Muammar
- Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Hussain Alsaffar
- Paediatric Endocrine and Diabetics Unit, Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Noura Al Hassani
- Department of Paediatrics, Tawam Hospital and UAE College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rasha Odeh
- Department of Paediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Haya Alkhayyat
- Bahrain Defence Force Royal Medical Services Military Hospital, West Riffa, Kingdom of Bahrain, Kingdom of Bahrain, Royal College of Surgeons in Ireland Medical University of Bahrain, Adliya, Bahrain
| | - Aisha Al Sinani
- National Diabetic and Endocrine Center, Royal Hospital, Muscat, Oman
| | - Najya Attia
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sarah Adhami
- Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Nancy Elbarbary
- Diabetes Unit, Department of Pediatrics, Faculty of medicine, Ain Shams University, Cairo, Egypt.
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Oudat RI, Abualruz HS, Al-Shiek NKA, Al-Mashaqba EA, Al-Hiari RA, Alsoukhni HA, Hammad MAA. Sickle Cell Disease in Jordan: The Experience of a Major Referral Center. Med Arch 2021; 75:27-30. [PMID: 34012195 PMCID: PMC8116085 DOI: 10.5455/medarh.2021.75.27-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Sickle cell disorders are the most frequently encountered hemoglobin variants in Jordan. Both alpha and beta thalassemias are also prevalent in this population. However, studies on the interaction between these hemoglobin disorders are lacking. Aim To determine the genotypes responsible for Sickle cell disease in Jordan, by retrospectively reviewing the data from a major referral center in the country's capital. Methods A total 29,712 peripheral blood samples referred and investigated for hemoglobinopathies over a 10-year period at Princess Iman Center at Amman, Jordan were retrospectively reviewed. In addition to full blood counts, high performance liquid chromatography, those who were identified with sickle cell hemoglobin were studied using polymerase chain reaction and reverse hybridization to determine the various sickle cell disease genotypes. Results Out of the (29,712) blood samples, 450 were sickle cell trait, while 216 had sickle cell disease. Of the latter: 120 were found to be cases of Sickle cell anemia (Hb SS), 66 were compound heterozygous for Sickle cell and a beta thalassemia mutation (Sickle/β-thalassemia), while 30 had concomitant alpha thalassemia (HbSS/alpha thalassemia). The most frequent genotype associated with sickle/β-thalassemia was HbS/ IVS-110 (G>A), followed by Hb S/IVS-I-6 (T>C), HbS/IVS-II-745 (C>G) and HbS/ IVS-II-1 (G>A). While the most frequent alpha genotype detected in HbSS/α-thalassemia samples was (-α3.7/αα) followed by (-α3.7/-α3.7). Hb SS patients had the severest hematological phenotype compared to those with sickle/β-thalassemia and sickle/ α-thalassemia. Furthermore, within the sickle/β-thalassemia subgroup the least severe hematological phenotype was encountered in HbS/IVS-1-6 (T>C), while the most severe in HbS/IVS-II-1 (G>A) genotype. Conclusion The most frequent Sickle cell disease genotype in Jordanians is Sickle cell anemia (HbSS), followed by Sickle/β-thalassemia and least frequent is HbSS/alpha thalassemia. The concomitant identified thalassemia mutations were consistent with their spectrum among the Jordanian population.
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Affiliation(s)
- Raida I Oudat
- Department of Hematopathology, Princess Iman Research and Laboratory Sciences Center, Amman, Jordan
| | - Heba S Abualruz
- Department of Hematopathology, Princess Iman Research and Laboratory Sciences Center, Amman, Jordan
| | - Nazih Kh Abu Al-Shiek
- Department of Hematopathology, Princess Iman Research and Laboratory Sciences Center, Amman, Jordan
| | - Eman A Al-Mashaqba
- Department of Hematopathology, Princess Iman Research and Laboratory Sciences Center, Amman, Jordan
| | - Rawan A Al-Hiari
- Department of Hematopathology, Princess Iman Research and Laboratory Sciences Center, Amman, Jordan
| | - Hala A Alsoukhni
- Department of Mathematics, Al-Zaytoonah University of Jordan, Amman, Jordan
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Khan AM, Al-Sulaiti AM, Younes S, Yassin M, Zayed H. The spectrum of beta-thalassemia mutations in the 22 Arab countries: a systematic review. Expert Rev Hematol 2020; 14:109-122. [PMID: 33317346 DOI: 10.1080/17474086.2021.1860003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the mutational spectrum in the HBB gene in Arab patients with β-thal. METHODS Authors searched five databases (PubMed, Science Direct, Scopus, Web of Science, and Google Scholar) from the time of inception until March 2020. RESULTS The authors search strategy yielded 3,229 citations, of which 48 eligible studies captured. 105 mutations were captured, of these, 99 were shared between Arabs and other ethnic groups, six mutations were unique to Arabs (c.92 + 2 T > G, c.-240 G > A, c.150delC, c.420dupT, deletion of 192 bp spanning exon 1, intron 1, and the first two bases of exon 2 of HBB gene, and deletion of 9.6 kb, including exon 1 and intron 2 of HBB gene). The most common HBB gene mutations among Arabs were c.93-21 G > A, c.118 C > T, c.92 + 1 G > A, c.92 + 6 T > C, c.92 + 5 G > C, c.315 + 1 G > A, and c.27dupG. Consanguinity is high among Arab patients with β-thal. Migration into Arab countries led to allelic heterogeneity among Arab patients with β-thal. CONCLUSION Our findings present a platform for further genetic epidemiological studies for Arab patients with β-thal.
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Affiliation(s)
- Aisha Moeen Khan
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
| | - Asma Mohammed Al-Sulaiti
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
| | - Salma Younes
- Translational Research Institute, Women's Wellness and Research Center, Hamad Medical Corporation , Qatar
| | - Mohamed Yassin
- Department of Hematology and BMT, National Center for Cancer Care and Research, Hamad Medical Corporation , Doha, Qatar
| | - Hatem Zayed
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
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Mansi K, Tabaza Y, Aburjai T. The iron chelating activity of Gundelia tournefortii in iron overloaded experimental rats. JOURNAL OF ETHNOPHARMACOLOGY 2020; 263:113114. [PMID: 32736049 DOI: 10.1016/j.jep.2020.113114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 05/26/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Gundelia tournefortii is a member of the Asteraceae (Compositae) family which is widely consumed as edible plant in the Eastern Mediterranean. In folkloric medicine, it is used for the treatment of various diseases and conditions, including pain, liver diseases, kidney stones and inflammations. AIM OF THE STUDY Recently, many commoners use this plant as adjuvant therapy for treating symptoms associated with liver diseases and thalassemia. Thus, the present study was conducted to evaluate, biochemically, the iron chelating activity of G. tournefortii methanolic extract in iron overloaded rats. MATERIALS AND METHODS Fifty Wister male rats were divided into five groups: one group was a healthy control, while iron overload was induced in the other four groups by 100 mg/kg iron-dextran. Of these, one group was left untreated as a control, while the other three groups were treated with 50 mg/kg deferoxamine, 100 mg/kg and 200 mg/kg of G. tournefortii methanolic extract, respectively. The total flavonoid and phenolic contents of the methanolic extract were estimated. The biochemical assessment was performed by measuring blood levels of iron, ferritin, liver biomarkers (ALT, ALP and AST), cardiac biomarkers (CPK and LDH) and lipid profile. RESULTS Not only the blood levels of iron, ferritin, liver biomarkers and cardiac biomarkers were reduced significantly by G. tournefortii methanolic extract, but also the lipid profile was improved. This clearly supports the chelating activity of G. tournefortii and its hepatoprotective and cardioprotective effects in iron overloaded rats. CONCLUSIONS This highlights the value of medicinal plants as alternative therapies for iron overload conditions such as thalassemia.
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Affiliation(s)
- Kamal Mansi
- Department of Medical Laboratory Science, Faculty of Science, Al Al-Bayt University, P.O. Box 130040, Mafraq, 25113, Jordan.
| | - Yahia Tabaza
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman, 11942, Jordan.
| | - Talal Aburjai
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman, 11942, Jordan.
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Genetic epidemiology of hemoglobinopathies among Iraqi Kurds. J Community Genet 2020; 12:5-14. [PMID: 33222097 DOI: 10.1007/s12687-020-00495-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/08/2020] [Indexed: 10/22/2022] Open
Abstract
Hemoglobinopathies are major health problems among Iraqi Kurds, who are a distinct ethnic group inhabiting North and Northeastern Iraq. We reviewed published literature on these disorders in this part of the world, and it was revealed that the most prevalent is β-thalassemia with carrier rates of 3.7-6.9%. Alpha thalassemia is less prevalent with carrier rates of 0.03-1.22%, while the sickle cell gene is variably distributed with carrier rates of 0.06-1.2%. Other structural hemoglobinopathies and δβ-thalassemia are sporadic. Twenty-seven different β-thalassemia mutations were identified, with seven constituting 82% of 1039 chromosomes characterized, namely: IVS-II-1 (G>A), IVS-I-6 (T>C), IVS-I-I (G>A), codon 8 (-AA), codon 8/9 (+G), IVS-I-110 (G>A), and codon 5 (-CT). There were notable regional variations in the distribution of β-thalassemia mutations, with Cd44 being mainly prevalent in the North, while IVS-I-110 is mainly prevalent in the East. In relevance to α-thalassemia, ten different mutations were detected, with the four most frequent constituting 92.4% of 262 alleles characterized being: -α3.7, --MED, α-5ntα, and αPolyA1α. In relevance to sickle cell gene, it is seen in the northern part of the region bordering Turkey, with comparable prevalence rates, and is associated, similar to Turkey, mainly with the Benin haplotype, unlike that in Southern Iraq where it is associated with the Arab-Indian haplotype, similar to Eastern Arabian Peninsula. Given the high prevalence of hemoglobinopathies in the region, and the high rates of consanguineous marriages, a preventive program was initiated in 2008, and results of its first 5 years were promising, though there are still many outstanding challenges that require addressing.
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Epidemiology of Thalassemia in Gulf Cooperation Council Countries: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1509501. [PMID: 33178817 PMCID: PMC7644312 DOI: 10.1155/2020/1509501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/15/2020] [Accepted: 10/20/2020] [Indexed: 01/11/2023]
Abstract
Background Thalassemia has a burden on the healthcare systems of many countries. About 56000 conceptions result in thalassemia, globally. Objective To assess the epidemiological profile of thalassemia in the Gulf Cooperation Council (GCC) countries. Methods A systematic search was conducted in MEDLINE/PubMed (National Library of Medicine), CINAHL, and Embase. Relevant observational studies reporting the epidemiology of thalassemia among the GCC population were selected. Data on the prevalence, frequency, and complications of thalassemia were extracted. The quality of the retrieved studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale. Results Eighteen studies (14 cross-sectional studies, two retrospective observational studies, and two retrospective analysis) with a total of 3343042 participants were included in this systematic review. Of the 18 studies, 11 studies were conducted in Saudi Arabia, two in the Kingdom of Bahrain, one in Kuwait, three in the United Arab Emirates (UAE), and one in Qatar. The prevalence of thalassemia among children below five years of age ranged from 0.25% to 33%, while it was 0.9% in children above five years and from 0.035% to 43.3% among adult thalassemia patients. The most-reported risk factors were consanguineous marriage and high-risk marriage. There was a lack of data regarding mortality rates in thalassemia. Conclusions Despite the premarital screening and genetic counseling (PMSGC) program for thalassemia, the incidence of high-risk couple marriages in GCC countries cannot be effectively diminished. This study suggested that the PMSGC program should adopt more attention for the high-risk areas, to enhance the level of consciousness about the hemoglobinopathy diseases and the consequences of consanguinity among the at-risk couple.
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Al Thwiby NM, Hussien NA, Bayoumy ES, Shokary M. HV2 fragment mutations in β-thalassemia patients and a new base pair insertion of high-altitude cases. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:283-293. [PMID: 33224572 PMCID: PMC7675125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
Worldwide, thalassemia represents one of the most common genetic disorders. There is a prevalence of Beta-thalassemia in Kingdom of Saudi Arabia (KSA), however there is a genetic counseling availability and an existence of mandatory premarital testing policy. Few studies detect molecular mutations of thalassemia genes in different KSA governates, including Makkah, Hufuf, Qatif, and Dammam but in our peer knowledge there is no reports on high altitude Taif region. The aim of the present study is to evaluate the molecular mutation analysis of β-thalassemia gene in El Taif province (as a high-altitude area) patients of KSA and to estimate the iron overload toxicity due to thalassemia syndrome on the hotspot noncoding D-loop region (hypervariable, HV2 gene fragment) of mtDNA. Blood samples were collected from total 25 β-thalassemia patients and 25 normal control that were used for HPLC, hematological analysis and different molecular evaluations. Extracted nuclear DNA from blood sample was used to detect known mutations accompanied with β-thalassemia in other countries using PCR-ARMS technique targeting IVSII-1, IVSI-5, Codon 8/9, Cd44 and Cd5 genes' mutations. Moreover, mtDNA was used to detect point of mutation of HV2 fragment in the D-loop region using PCR-SSCP and then sequencing. Results show significant increase in the level of HbA2 and decrease of HbA in comparison to control by using HPLC. PCR-ARMS reports that all β-thalassemia patients have heterozygous alleles of wild and mutated regions with nucleotide transition/transversion of IVSI-5 (AC>AG), Codon 8/9 (CT>CC), and Cd44 (GG>GA), however no point of mutation was detected in IVSII-1 (AC>AT) Cd5 (CT>CG) genes. Moreover, PCR-SSCP shows points of mutations for β-thalassemia HV2 fragment that were confirmed by sequencing in the form of base pairs deletion, insertion and transition/transversion. For the first time, the present study reports the presence of 2 bps found in HV2 region that might be specific to KSA nations and not found in other countries. In conclusion, our results were in concurrent with other studies in the presence of specific genetic mutations in β-thalassemia patients that is accompanied with points of mutations in HV2 region of high altitude Taif governate.
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Affiliation(s)
- Nsreen M Al Thwiby
- Biology Department, Faculty of Science, Taif UniversityAl-Hawyeia 888, Kingdom of Saudi Arabia
| | - Nahed A Hussien
- Biology Department, Faculty of Science, Taif UniversityAl-Hawyeia 888, Kingdom of Saudi Arabia
- Zoology Department, Faculty of Science, Cairo UniversityGiza 12613, Egypt
| | - Eman S Bayoumy
- Biochemistry Department, Faculty of Medicine, Taif UniversityAl-Hawyeia 888, Kingdom of Saudi Arabia
- Biochemistry Department, Faculty of Medicine for Girls, Al-Azhar UniversityCairo, Egypt
| | - Mohammed Shokary
- Haematology Department, King Abdulaziz Specialist HospitalTAIF, Kingdom of Saudi Arabia
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Nadar SK, Daar S, Abdelmottaleb WA, Shaikh MM, Al Mahrouqi H, Al-Raiisi M, Hassan M, Al Rawahi B, Al Rahbi S. Abnormal diastolic function and Global longitudinal strain in patients with Thalassemia Major on long term chelation therapy. Int J Cardiovasc Imaging 2020; 37:643-649. [PMID: 32965605 DOI: 10.1007/s10554-020-02036-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
Cardiac complications are the major cause of mortality in patients with Thalassemia major (TM). Cardiac T2* MRI is currently the gold standard for assessing myocardial iron concentration. The aim of our study was to assess whether any echocardiographic parameter would correlate with these findings in patients well established on chelation therapy. This was a prospective study on patients with TM who are regularly followed in our clinic. Patients had a cardiac MRI and echocardiogram within 2 months of each other. Echo parameters included global longitudinal strain and diastolic function. We also compared these findings with those from a cohort of thalassemia intermedia (TI) and normal controls. A total of 84 patients (mean age 26.3 ± 6.1 years, 42.8% male) with TM were enrolled. All had normal left ventricular ejection fraction and only 8 patients had MRI T2* < 10. As compared to 17 patients with TI and 53 controls, these patients had significantly higher E/E' and lower pulmonary vein s/dd ratio suggesting early diastolic dysfunction. 28 patients fulfilled criteria for diastolic dysfunction even in the presence of normal MRI T2*. Global longitudinal strain (GLS) was significantly lower in the TM group as compared to the TI and controls. We found no correlation between any of the echo findings and the MRI T2*in TM patients. In patients with thalassemia and MRI T2* > 20 ms features of diastolic dysfunction persist even in the presence of normal LV function and normal GLS. This suggests that diastolic function remains abnormal even when myocardial iron concentrations are normal and follow up therefore is essential.
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Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman.
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre At Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Wael A Abdelmottaleb
- Department of Medicine, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Muhammad M Shaikh
- Department of Medicine, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Hafsa Al Mahrouqi
- Department of Clinical Physiology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Majida Al-Raiisi
- Department of Clinical Physiology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Moez Hassan
- Department of Hematology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Badar Al Rawahi
- Department of Hematology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
| | - Sarah Al Rahbi
- Department of Hematology, Sultan Qaboos University Hospital, POBox 38, Muscat, 123, Oman
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Amjad F, Fatima T, Fayyaz T, Khan MA, Qadeer MI. Novel genetic therapeutic approaches for modulating the severity of β-thalassemia (Review). Biomed Rep 2020; 13:48. [PMID: 32953110 PMCID: PMC7484974 DOI: 10.3892/br.2020.1355] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
Thalassemia is a genetic haematological disorder that arises due to defects in the α and β-globin genes. Worldwide, 0.3-0.4 million children are born with haemoglobinopathies per year. Thalassemic patients, as well as their families, face various serious clinical, socio-economic, and psychosocial challenges throughout their life. Different therapies are available in clinical practice to minimize the suffering of thalassemic patients to some extent and potentially cure the disease. Predominantly, patients undergo transfusion therapy to maintain their haemoglobin levels. Due to multiple transfusions, the iron levels in their bodies are elevated. Iron overload results in damage to body organs, resulting in heart failure, liver function failure or endocrine failure, all of which are commonly observed. Certain drugs have been developed to enhance the expression of the γ-gene, which ultimately results in augmentation of fetal haemoglobin (HbF) levels and total haemoglobin levels in the body. However, its effectiveness is dependent on the genetic makeup of the individual patient. At present, allogeneic haematopoietic Stem Cell Transplantation (HSCT) is the only practically available option with a high curative rate. However, the outcome of HSCT is strongly influenced by factors such as age at transplantation, irregular iron chelation history before transplantation, histocompatibility, and source of stem cells. Gene therapy using the lentiglobin vector is the most recent method for cure without any mortality, graft rejection and clonal dominance issues. However, delayed platelet engraftment is being reported in some patients. Genome editing is a novel approach which may be used to treat patients with thalassemia; it makes use of targeted nucleases to correct the mutations in specific DNA sequences and modify the sequence to the normal wild-type sequence. To edit the genome at the required sites, CRISPR/Cas9 is an efficient and accurate tool that is used in various genetic engineering programs. Genome editing mediated by CRISPR/Cas9 has the ability to restore the normal β-globin function with minimal side effects. Using CRISPR/Cas9, expression of BCL11A can be downregulated along with increased production of HbF. However, these genome editing tools are still under in-vitro trials. CRISPR/Cas9 has can be used for precise transcriptional regulation, genome modification and epigenetic editing. Additional research is required in this regard, as CRISPR/Cas9 may potentially exhibit off-target activity and there are legal and ethical considerations regarding its use.
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Affiliation(s)
- Fareeha Amjad
- Department of Microbiology and Molecular Genetics, University of The Punjab, Lahore, Punjab 54590, Pakistan
| | - Tamseel Fatima
- Department of Microbiology and Molecular Genetics, University of The Punjab, Lahore, Punjab 54590, Pakistan
| | - Tuba Fayyaz
- Department of Microbiology and Molecular Genetics, University of The Punjab, Lahore, Punjab 54590, Pakistan
| | - Muhammad Aslam Khan
- Sundas Molecular Analysis Centre (SUNMAC), Sundas Foundation, Lahore, Punjab 54000, Pakistan
| | - Muhammad Imran Qadeer
- Department of Microbiology and Molecular Genetics, University of The Punjab, Lahore, Punjab 54590, Pakistan.,Sundas Molecular Analysis Centre (SUNMAC), Sundas Foundation, Lahore, Punjab 54000, Pakistan
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Sadullah RK, Atroshi SD, Al-Allawi NA. Complications and Challenges in the Management of Iraqi Patients with β-Thalassemia Major: A Single-center Experience. Oman Med J 2020; 35:e152. [PMID: 32724663 PMCID: PMC7383834 DOI: 10.5001/omj.2020.72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/09/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES We sought to assess the complications and challenges facing the management of β-thalassemia major (β-TM) in Iraq. METHODS A total of 150 consecutive patients with β-TM who were registered at a main thalassemia center in Northern Iraq were enrolled in the study. The patients had their records reviewed, were clinically evaluated, and investigated for various complications. RESULTS Our patient cohort had a median age of 13 years (range: 1-35 years) and a male to female ratio of 1:1.2. Their median serum ferritin was 2762 µg/L, all were on regular transfusions, 94.7% were on chelation therapy, and 38.0% were splenectomized. Pre-transfusion hemoglobin levels were 3 9.0 g/dL in 38.7% of the patients. Short stature was encountered in 33.9% of those aged ≤ 20 years, and skeletal changes were noted in 50.7%. Iron overload associated complications, including hypogonadism, hypothyroidism, hypoparathyroidism, diabetes mellitus, and heart failure, were encountered in 52.8%, 7.3%, 3.3%, 3.3%, and 2.7%, respectively. Hepatitis C virus (HCV) antibodies were detectable in 35.3%, while HIV antibodies and hepatitis B surface antigen were not detectable in any. Patients with diabetes mellitus, heart failure, HCV antibodies, and hypoparathyroidism were significantly older than those without these complications. Hypogonadism was the only complication associated with significantly higher serum ferritin levels. Hypogonadism, heart failure, HCV antibodies, and diabetes were significantly more frequent among the splenectomized patients. CONCLUSIONS The management of β-TM in this cohort of Iraqi patients is still suboptimal, and the need to ensure timely transfusions and optimize chelation, as well as a more robust iron overload assessment, should be underscored.
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Affiliation(s)
| | - Sulav D. Atroshi
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
| | - Nasir A. Al-Allawi
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
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Macharia AW, Mochamah G, Uyoga S, Ndila CM, Nyutu G, Tendwa M, Nyatichi E, Makale J, Ware RE, Williams TN. β-Thalassemia pathogenic variants in a cohort of children from the East African coast. Mol Genet Genomic Med 2020; 8:e1294. [PMID: 32394645 PMCID: PMC7336762 DOI: 10.1002/mgg3.1294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND β-Thalassemia is rare in sub-Saharan Africa. Previous studies have suggested that it is limited to specific parts of West Africa. Based on hemoglobin A2 (HbA2 ) concentrations measured by HPLC, we recently speculated that β-thalassemia might also be present on the East African coast of Kenya. Here, we follow this up using molecular methods. METHODS We used raised hemoglobin A2 (HbA2 ) values (> 4.0% of total Hb) to target all HbAA members of a cohort study in Kilifi, Kenya, for HBB sequencing for β-thalassemia (n = 99) together with a sample of HbAA subjects with lower HbA2 levels. Because HbA2 values are artifactually raised in subjects carrying sickle hemoglobin (HbS) we sequenced all participants with an HPLC pattern showing HbS without HbA (n = 116) and a sample with a pattern showing both HbA and HbS. RESULTS Overall, we identified 83 carriers of four separate β-thalassemia pathogenic variants: three β0 -thalassemia [CD22 (GAA→TAA), initiation codon (ATG→ACG), and IVS1-3' end del 25bp] and one β+ -thalassemia pathogenic variants (IVS-I-110 (G→A)). We estimated the minimum allele frequency of all variants combined within the study population at 0.3%. CONCLUSIONS β-Thalassemia is present in Kilifi, Kenya, an observation that has implications for the diagnosis and clinical care of children from the East Africa region.
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Affiliation(s)
| | | | - Sophie Uyoga
- KEMRI-Wellcome Trust Research ProgrammeKilifiKenya
| | | | - Gideon Nyutu
- KEMRI-Wellcome Trust Research ProgrammeKilifiKenya
| | | | | | | | - Russell E. Ware
- Cincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Thomas N. Williams
- KEMRI-Wellcome Trust Research ProgrammeKilifiKenya
- Department of MedicineImperial CollegeSt Mary’s HospitalLondonUK
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Abdulqader AMR, Mohammed AI, Mohammed NI. Red Cell Alloimmunization and Autoimmunization in Multi-Transfused Thalassemia Patients in Sulaymaniyah Province-Iraq. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2020. [DOI: 10.15324/kjcls.2020.52.2.98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Ali Ibrahim Mohammed
- Department of Pathology, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
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Naveed M, Al-Serkal Y, Al-Nuaimi S, Al-Blooshi K, Majed Al-Mahiri N, Khan Y, Naqvi SA, Preman N. Improved efficiency and patient safety through bespoke electronic thalassaemia care module. BMJ Health Care Inform 2020; 26:bmjhci-2019-100094. [PMID: 31533923 PMCID: PMC7062350 DOI: 10.1136/bmjhci-2019-100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
Objectives To investigate the impact of electronic medical record (EMR) on improvement of healthcare parameters in a thalassaemia centre located at the Fujairah Hospital, Fujairah, UAE. Materials and methods A hospital-wide EMR system (Wareed) was implemented across the hospitals in the Ministry of Health and Prevention, UAE, including two major thalassaemia centres. We aim to investigate the impact of this intervention across a number of healthcare parameters over two quarters (before and after implementation of the system). Results Since preimplementation data were not available for one facility, comparisons were made between parameters in two quarters in Fujairah hospital only. After introduction of Wareed, we found an increase in number of appointments (12%) (p=0.00), decrease in the number of appointment cancellations due to non-availability of blood products (p=0.02), reduction in the time to cannulation (p=0.00), decrease in number of physician days (p=0.295) among other parameters observed. Discussion Research shows that EMR systems have a positive impact on reduction in medical expenditure, improvement of healthcare quality and overall health outcomes. thalassaemia is highly prevalent in the Middle Eastern countries and drains the medical, social and financial resources of these nations. Our study is an attempt to create an insight into the difference in healthcare parameters before and after introduction of the system. Conclusion Being the first of a kind in this region, our study created favourable evidence that introduction of an EMR has an overall positive impact on the healthcare delivery system for thalassaemia care.
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Affiliation(s)
- Mohamed Naveed
- Hospital Department, Ministry of Health and Prevention, Fujairah, United Arab Emirates
| | - Yousif Al-Serkal
- Hospital sector, Ministry of Health and Prevention, Dubai, United Arab Emirates
| | - Sumaya Al-Nuaimi
- Hospital Department, Ministry of Health and Prevention, Fujairah, United Arab Emirates
| | - Kalthoom Al-Blooshi
- Hospital Department, Ministry of Health and Prevention, Dubai, United Arab Emirates
| | - Noor Majed Al-Mahiri
- Hospital Department, Ministry of Health and Prevention, Dubai, United Arab Emirates
| | - Yasir Khan
- Cerner Middle East, Dubai, United Arab Emirates
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Amin SS, Jalal SD, Ali KM, Mohammed AI, Rasool LK, Osman TJ. Beta-Thalassemia Intermedia: A Single Thalassemia Center Experience from Northeastern Iraq. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2807120. [PMID: 32190657 PMCID: PMC7066418 DOI: 10.1155/2020/2807120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the molecular characterization and disease-associated complications of beta-thalassemia intermedia (β-TI) patients in Sulaymaniyah province, northeastern Iraq. METHODS A total of 159 β-TI) patients in Sulaymaniyah province, northeastern Iraq. β-TI) patients in Sulaymaniyah province, northeastern Iraq. RESULTS Nineteen different β-globin gene mutations arranged in 37 various genotypes were determined. The most frequent were IVS-II-I (G>A) (47.2%), followed by IVS-I-6 (T>C) (23.3%) and IVS-I-110 (G>A) (5%). Among disease-related morbidities documented, bone disease amounted to 53% (facial deformity and osteoporosis), followed by endocrinopathies 17.6% (growth retardation and subclinical hypothyroidism), cholelithiasis 13.8%, pulmonary hypertension 11.3%, and abnormal liver function test 7.5%, whereas venous thrombosis, extramedullary hemopoiesis, and leg ulcer were less frequently observed. Age ≥ 35 and female sex were risk factors for cholelithiasis, while age was an independent risk for hypothyroidism and female sex was associated with increased risk for osteoporosis. Mean serum ferritin of ≥1000 μg/L was associated with an increased risk of osteoporosis, whereas chelation therapy was protective for a multitude of other complications. Transfusion, on the other hand, increased the risk of osteoporosis, yet it was protective for cholelithiasis and hypothyroidism. Moreover, splenectomy was protective for cholelithiasis, although it was an independent risk for hypothyroidism. Finally, hydroxyurea was associated with an increased risk of osteoporosis, while it was protective for cholelithiasis. Discussion and Conclusion. β +-thalassemia mutation had contributed to 41.25 of families with a less severe β-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of β-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.β-TI) patients in Sulaymaniyah province, northeastern Iraq. μg/L was associated with an increased risk of osteoporosis, whereas chelation therapy was protective for a multitude of other complications. Transfusion, on the other hand, increased the risk of osteoporosis, yet it was protective for cholelithiasis and hypothyroidism. Moreover, splenectomy was protective for cholelithiasis, although it was an independent risk for hypothyroidism. Finally, hydroxyurea was associated with an increased risk of osteoporosis, while it was protective for cholelithiasis. Discussion and Conclusion. β +-thalassemia mutation had contributed to 41.25 of families with a less severe β-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of β-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.Discussion and Conclusion. β +-thalassemia mutation had contributed to 41.25 of families with a less severe β-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of β-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.β-TI) patients in Sulaymaniyah province, northeastern Iraq. β-TI) patients in Sulaymaniyah province, northeastern Iraq.
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Affiliation(s)
- Shaema Salih Amin
- Sulaymaniyah Directorate of Health, Hewa Oncology Hospital, Sulaymaniyah, Iraq
| | - Sana Dlawar Jalal
- Department of Pathology, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
| | - Kosar Muhammed Ali
- Department of Medicine, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
| | - Ali Ibrahim Mohammed
- Department of Pathology, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
| | | | - Tara Jamel Osman
- Thalassemia and Congenital Blood Disorders Center, Sulaymaniyah 46001, Iraq
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Al-Riyami AZ, Daar S, Kindi SA, Madhani AA, Wali Y, Rawahi MA, Zadjali SA. α-Globin Genotypes Associated with Hb H Disease: A Report from Oman and a Review of the Literature from the Eastern Mediterranean Region. Hemoglobin 2020; 44:20-26. [PMID: 32019385 DOI: 10.1080/03630269.2020.1720709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
α-Thalassemia (α-thal) is the most common autosomal recessive hemoglobinopathy. There is a vast diversity and geographical variability in underlying genotypes in Hb H (β4) patients. Herein, we describe the genotypes found in the largest report of Omani Hb H patients. Moreover, we reviewed and summarized the literature published from the Eastern Mediterranean region. A retrospective review of all genetically confirmed Hb H disease patients diagnosed between 2007 and 2017 at Sultan Qaboos University Hospital, Muscat, Oman, was performed. Hematological parameters and clinical presentations were assessed. Both α-globin genes were screened for deletional and nondeletional mutations using a stepwise diagnostic strategy as described before. A total of 52 patients (27 females and 25 males) with a mean age of 20.6 years (range 0.23-80.0) were molecularly confirmed to carry Hb H disease. The patients had a hemoglobin (Hb) level of 9.3 g/dL (range 5.7-13.0) and mean corpuscular volume (MCV) of 58.4 fL (range 48.2-82.1). A total of eight genotype combinations were identified, with α2 polyadenylation signal mutation (polyA1) (AATAAA>AATAAG (αPA1α/αPA1α), often cited as αT-Saudiα/αT-Saudiα, being the most common (53.8%) followed by -α3.7/- -MED I (28.8%). Our cohort also included patients with combinations of αPA1 with other Hb variants: αPA1α/αPA1α with Hb S (HBB: c.20A>T) trait (n = 2), -α3.7/αPA1α (n = 2) and αcodon 19α (HBA2: c.56delG)/αPA1α (n = 1). Nondeletional Hb H disease due to the αPA1 mutation is the most common in Omanis. Molecular diagnosis is necessary for accurate confirmation of the diagnosis of α-thal, determination of underlying genotypes, follow-up and counseling.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Salam Al Kindi
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ali Al Madhani
- Department of Medicine, Sohar Hospital, Ministry of Health, Muscat, Oman
| | - Yasser Wali
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al Rawahi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shoaib Al Zadjali
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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AbdulAzeez S, Almandil NB, Naserullah ZA, Al-Jarrash S, Al-Suliman AM, ElFakharay HI, Borgio JF. Co-inheritance of alpha globin gene deletion lowering serum iron level in female beta thalassemia patients. Mol Biol Rep 2020; 47:603-606. [PMID: 31705350 DOI: 10.1007/s11033-019-05168-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022]
Abstract
In the Eastern province of Saudi Arabia, thalassemia is highly common. Data on the effect of alpha globin gene variation on the concentration of iron on transfusion dependent Saudis are scanty. A total of 166 transfusions dependent β-thalassemia were included in this study to understand association between the alpha globin gene variation and concentration of iron. Using multiplex PCR, the alpha globin gene deletions were identified. Also, HBA1 and HBA2 genes were sequenced by Sanger sequencing. Saudi transfusion dependent female β-thalassemia patients with wild alpha globin genotype (αα/αα) were observed with iron level beyond the normal range. However, normal range of iron was observed in transfusion dependent Saudi female beta thalassemia patients co-inherited with double (-α3.7/-α3.7, or --Fil/αα or --MED/αα or - (α) 20.5/αα) or double heterozygosity (- -/-α3.7) alpha globin gene deletions, which is significantly (p < 0.0001) less compared to the Saudi transfused female with wild alpha globin genotype (αα/αα). The co-inheritance alpha globin gene deletions in female beta thalassemia patients were significantly lowering serum iron. Detailed studies can be taken forward to identify the molecular pathways involved in globin gene deletion as modulator.
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Affiliation(s)
- Sayed AbdulAzeez
- Department of Genetic Research, Institute for Research and Medical Consultation (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor B Almandil
- Department of Clinical Pharmacy Research, Institute for Research and Medical Consultation (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | | | | | - J Francis Borgio
- Department of Genetic Research, Institute for Research and Medical Consultation (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient. Case Rep Neurol Med 2019; 2019:5827626. [PMID: 31781438 PMCID: PMC6855030 DOI: 10.1155/2019/5827626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022] Open
Abstract
Background Extramedullary hematopoiesis (EMH) is one of the rare causes of spinal cord compression (SCC). It results from noncancerous proliferation of hematopoietic tissue outside the bone marrow as a compensatory mechanism for ineffective erythropoiesis. It occurs in the paraspinal area in 11-15% of thalassemic patients in intermediate and severe cases causing a paraspinal compressive mass. We present a rare case of spinal EMH with thoracic cord compression in a 22-year-old female with beta thalassemia who presented with paraparesis and we provide a review of literature. Case Report A 22-year-old female patient with a known history of beta thalassemia presented with subacute onset of weakness and numbness of both lower limbs with a sensory level at T6. Magnetic resonance imaging (MRI) of the dorsal spine showed cord compression secondary to paraspinal EMH from T2 to T9 with most prominent compression over T5. She was managed with blood transfusion and low-dose radiotherapy. Conclusion Although rare, EMH should be suspected in thalassemic patients presenting with paraplegia. Treatment with blood transfusions is usually effective. Other options include radiotherapy, surgery, hydroxyurea or a combination of these modalities.
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Facile spectroscopy and atomic force microscopy for the discrimination of α and β thalassemia traits and diseases: A photodiagnosis approach. Photodiagnosis Photodyn Ther 2019; 27:149-155. [DOI: 10.1016/j.pdpdt.2019.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
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Romdhane L, Mezzi N, Hamdi Y, El-Kamah G, Barakat A, Abdelhak S. Consanguinity and Inbreeding in Health and Disease in North African Populations. Annu Rev Genomics Hum Genet 2019; 20:155-179. [PMID: 31039041 DOI: 10.1146/annurev-genom-083118-014954] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
North Africa is defined as the geographical region separated from the rest of the continent by the Sahara and from Europe by the Mediterranean Sea. The main demographic features of North African populations are their familial structure and high rates of familial and geographic endogamy, which have a proven impact on health, particularly the occurrence of genetic diseases, with a greater effect on the frequency and spectrum of the rarest forms of autosomal recessive genetic diseases. More than 500 different genetic diseases have been reported in this region, most of which are autosomal recessive. During the last few decades, there has been great interest in the molecular investigation of large consanguineous North African families. The development of local capacities has brought a substantial improvement in the molecular characterization of these diseases, but the genetic bases of half of them remain unknown. Diseases of known molecular etiology are characterized by their genetic and mutational heterogeneity, although some founder mutations are encountered relatively frequently. Some founder mutations are specific to a single country or a specific ethnic or geographic group, and others are shared by all North African countries or worldwide. The impact of consanguinity on common multifactorial diseases is less evident.
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Affiliation(s)
- Lilia Romdhane
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, 1002 Tunis Belvédère, Tunisia; .,Department of Biology, Faculty of Sciences of Bizerte, Université Tunis Carthage, 7021 Jarzouna, Tunisia
| | - Nessrine Mezzi
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, 1002 Tunis Belvédère, Tunisia;
| | - Yosr Hamdi
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, 1002 Tunis Belvédère, Tunisia;
| | - Ghada El-Kamah
- Department of Clinical Genetics, Human Genetics and Genome Research Division, National Research Centre, Cairo 12622, Egypt
| | - Abdelhamid Barakat
- Laboratoire de Génétique Humaine et Biologie Moléculaire, Département de Recherche Scientifique, Institut Pasteur du Maroc, 20100 Casablanca, Morocco
| | - Sonia Abdelhak
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, 1002 Tunis Belvédère, Tunisia;
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Skogberg N, Laatikainen T, Lilja E, Lundqvist A, Härkänen T, Koponen P. The association between anthropometric measures and glycated haemoglobin (HbA1c) is different in Russian, Somali and Kurdish origin migrants compared with the general population in Finland: a cross-sectional population-based study. BMC Public Health 2019; 19:391. [PMID: 30971258 PMCID: PMC6458679 DOI: 10.1186/s12889-019-6698-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/25/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Persons of African and Middle-Eastern origin living in European countries have a high prevalence of type 2 diabetes, accompanied by high prevalence of obesity among women but not always among men. The aim of this study was to examine whether there are differences in the association between anthropometric measures and glucose levels measured with glycated haemoglobin and fasting blood glucose among persons of migrant origin in Finland. METHODS Cross-sectional population-based data of the 30-64 year-old participants in the health examination of the Migrant Health and Wellbeing Study was used, selecting persons without diabetes (Russian origin n = 293, Somali origin n = 184, Kurdish origin n = 275). The reference group were non-diabetic participants in the Health 2011 Survey (n = 653), representative of the general Finnish population. Anthropometric measures included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR, available for Maamu Study participants only). RESULTS Depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-18% of variation in HbA1c among persons of Russian origin, 5-10% among persons of Somali origin, 1-3% among persons of Kurdish origin and 11-13% among the general population. Also depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-19% of variation in fasting blood glucose among persons of Russian origin, 15-20% among persons of Somali origin, 13-17% among persons of Kurdish origin and 16-17% among the general population. With exception for BMI, strength of the association between continuous anthropometric measures and HbA1c was significantly lower among persons of Kurdish origin compared with the general Finnish population (p = 0.044 for WC and p = 0.040 for WHtR). CONCLUSIONS A low degree of association between anthropometric measures and HbA1c was observed among persons of Kurdish origin. Findings of this study suggest caution is warranted when using HbA1c as a screening tool for glucose impairment among persons without diabetes in populations of diverse origin.
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Affiliation(s)
- Natalia Skogberg
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271 Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PL 1627, 70211 Kuopio, Finland
- Joint municipal authority for North Karelia social and health services, Tikkamäentie 16, 80210 Joensuu, Finland
| | - Eero Lilja
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271 Helsinki, Finland
| | - Annamari Lundqvist
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271 Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271 Helsinki, Finland
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271 Helsinki, Finland
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Alpha-Thalassemia in North Morocco: Prevalence and Molecular Spectrum. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2080352. [PMID: 31001551 PMCID: PMC6436373 DOI: 10.1155/2019/2080352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/09/2019] [Accepted: 02/24/2019] [Indexed: 12/31/2022]
Abstract
Unlike the other hemoglobinopathies, few researches have been published concerning α-thalassemia in Morocco. The epidemiological features and the mutation spectrum of this disease are still unknown. This regional newborn screening is the first to study α-thalassemia in the north of Morocco. During the period from January 2015 to December 2016, 1658 newborns umbilical blood samples were investigated. Suspected newborns were screened for α-globin defects using Gap-PCR and Multiplex Ligation-dependent Probe Amplification technique. The prevalence of α-thalassemia, its mutation spectrum, and its allelic frequencies were described for the first time in Morocco. Six different α-globin genetic disorders were detected in 16 neonates. This screening valued the prevalence of α-thalassemia in the studied population at 0.96% and showed the wide mutation spectrum and the heterogeneous geographical distribution of the disease. A high rate of carriers was observed in Laouamra, a rural commune in Larache province. Heterogeneity of α-globin alleles in Morocco explains the high variability of α-thalassemia severity. This diversity reflects the anthropological history of the country. These results would contribute to the prevention of thalassemia in Morocco directing the design of a nationwide screening strategy and awareness campaign.
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Abdelmawla D, Moemen D, Darwish A, Mowafy W. Hepatitis E virus prevalence in Egyptian children with transfusion-dependent thalassemia. Braz J Infect Dis 2019; 23:40-44. [PMID: 30826379 PMCID: PMC9427812 DOI: 10.1016/j.bjid.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/22/2018] [Accepted: 01/03/2019] [Indexed: 11/23/2022] Open
Abstract
Hepatitis E virus (HEV) infection is one of the major public health problems in developing countries. HEV can cause chronic infections in immunocompromised individuals e.g. thalassemic patients with increased risk of morbidity and mortality. In addition there is possibility of HEV transmission through blood transfusion. Therefore, the present study aimed to investigate the seroprevalence and risk factors of HEV infection in β-thalassemic children. Methods This cross-sectional study was conducted on 140 Egyptian children suffering from β-thalassemia, attending the hematology outpatient clinic from April to October 2016. Serum samples from patients were collected and anti-HEV antibodies; Immunoglobulin G (IgG) and Immunoglobulin M (IgM) were measured by enzyme-linked immunosorbent assay (ELISA). Results The seroprevalence of HEV in β-thalassemic chidren was relatively high (27.15%). Anti-HEV IgG prevalence was 24.29% while that of IgM was 2.86%. There was significant association between HEV infection and age, residence, liver enzymes and amount of blood transfusion per year. Conclusions Thalasemic patients are vulnerable to chronicity and increased risk of morbidity and mortality from HEV infection. Frequent assessment of liver enzymes in thalassemic patients to monitor subclinical HEV is recommended. Close monitoring and HEV screening of blood donations should be taken in consideration. Public awareness about HEV endemicity, modes of transmission, and risk hazards especially in high risk group should be done to reduce the disease burden.
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Affiliation(s)
- Doaa Abdelmawla
- Mansoura University, Faculty of Medicine, Department of Medical Microbiology and Immunology, Mansoura, Egypt
| | - Dalia Moemen
- Mansoura University, Faculty of Medicine, Department of Medical Microbiology and Immunology, Mansoura, Egypt.
| | - Ahmad Darwish
- Mansoura University, Faculty of Medicine, Department of Pediatrics, Mansoura, Egypt
| | - Wafaa Mowafy
- Mansoura University, Faculty of Medicine, Department of Medical Microbiology and Immunology, Mansoura, Egypt
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Murad H, Moassas F, Ghoury I, Mukhalalaty Y. Haplotype Analysis of Three Common β-Thalassemia Mutations in Syrian Patients. Hemoglobin 2019; 42:302-305. [PMID: 30669902 DOI: 10.1080/03630269.2018.1553789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
β-Globin haplotypes were used to investigate the origin of three common β-globin mutations, IVS-I-110 (G>A); HBB: c.93-21G>A, IVS-I-1 (G>A); HBB: c.92 + 1G>A and codon 39 (C>T); HBB: c.118C > T in Syrian patients. Haplotype analysis was done for 49 unrelated patients with β-thalassemia (β-thal) and 20 unrelated healthy subjects by polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) for the β-globin gene cluster of the following polymorphic restriction sites: HincII 5' to ε, HindIII 5' to Gγ, HindIII 5' to Aγ, HincII in ψβ, HincII 3' to ψβ, AvaII in β, and HinfI 3' to β. The IVS-I-110 mutation was associated with three haplotypes: I [+ - - - - + +] (79.4%), V [+ - - - - + -] (5.9%) and VII [+ - - - - - +] (14.7%), while, the two mutations IVS-I-1 and codon 39 were be linked to a single haplotype V (100.0%) and II [- + + - + + +] (100.0%), respectively. The normal chromosomes (βA/βA) were associated with four haplotypes, I (50.0%), II (7.5%), V (32.5%) and VII (10.0%). In the Syrian population, the IVS-I-110 mutation was associated with multi haplotypes, whereas the IVS-I-1 and codon 39 mutations have a single origin. More studies for the other mutations will be very useful for genetic epidemiological studies in Syria.
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Affiliation(s)
- Hossam Murad
- a Department of Molecular Biology and Biotechnology , Atomic Energy Commission of Syria , Damascus , Syria
| | - Faten Moassas
- a Department of Molecular Biology and Biotechnology , Atomic Energy Commission of Syria , Damascus , Syria
| | - Ifad Ghoury
- b Department of Radiation Medicine , Atomic Energy Commission of Syria , Damascus , Syria
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Habibi H, Atashi A, Abroun S, Noruzinia M. Synergistic Effect of Simvastatin and Romidepsin on Gamma-globin Gene Induction. CELL JOURNAL 2019; 20:576-583. [PMID: 30124006 PMCID: PMC6099151 DOI: 10.22074/cellj.2019.5589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/06/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Hemoglobinopathies such as beta-thalassemia and sickle cell disease (SCD) are inherited disorders that are caused by mutations in beta-globin chain. Gamma-globin gene reactivation can ameliorate clinical manifestations of betathalassemia and SCD. Drugs that induce fetal hemoglobin (HbF) can be promising tools for treatment of beta-thalassemia and SCD patients. Recently, it has been shown that Simvastatin (SIM) and Romidepsin (ROM) induce HbF. SIM is a BCL11a inhibitor and ROM is a HDAC inhibitor and both of these drugs are Food and Drug Administration (FDA)-approved for hypercholesterolemia and cutaneous T-cell lymphoma respectively. Our aim was to evaluate the synergistic effects of these drugs in inducing HbF. MATERIALS AND METHODS In our experimental study, we isolated CD34+ cells from five cord blood samples that were cultured in erythroid differentiation medium containing ROM and Simvastatin. Then Gamma-globin, BCL11a and HDAC gene expression were evaluated on the 7th and 14th day of erythroid differentiation by real-time polymerase chain reaction (PCR) and immunocytochemistry. RESULTS Our results showed that combination of SIM and ROM significantly increased Gamma-globin gene expression and inhibit BCL11a and HDAC expression compared to results of using each of them alone. SIM and ROM lead to 3.09- fold increase in HbF production compared to the control group. Also, SIM inhibited BCL11a expression (0.065-fold) and ROM inhibited HDAC1 expression (0.47-fold) as two important inhibitors of HbF production after birth. CONCLUSION We propose combination therapy of these drugs may be ameliorate clinical manifestation in beta-thalassemia and SCD with at least side effects and reduce the need for blood transfusion.
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Affiliation(s)
- Hussain Habibi
- Department of Hematology, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Amir Atashi
- Department of Hematology, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Electronic Address:
| | - Saeid Abroun
- Department of Hematology, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mehrdad Noruzinia
- Department of Medical Genetics, School of Medicine, Tarbiat Modares University, Tehran, Iran
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Al Moamen NJ, Thabet A, Mahdi F, Newton H, Salman E. Various α-Thalassemia Genotype Combinations of the Saudi-Type Polyadenylation Signal Mutation (αT-Saudiα) in the Population of Bahrain: An Update of Genotype-Phenotype Analyses. Hemoglobin 2018; 42:166-170. [DOI: 10.1080/03630269.2018.1499523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nabeel J. Al Moamen
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Ahmed Thabet
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Fawzia Mahdi
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Hema Newton
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Ebtihal Salman
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
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Al-Allawi N, Qadir SMA, Puehringer H, Chui DHK, Farrell JJ, Oberkanins C. The association of HBG2, BCL11A, and HMIP polymorphisms with fetal hemoglobin and clinical phenotype in Iraqi Kurds with sickle cell disease. Int J Lab Hematol 2018; 41:87-93. [PMID: 30216683 DOI: 10.1111/ijlh.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/14/2018] [Accepted: 08/14/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Fetal hemoglobin (HbF) is the major modifier for sickle cell disease (SCD) severity. HbF is modulated mainly by three major quantitative trait loci (QTL) on chromosomes 2, 6, and 11. METHODS Five SNPs in the three QTLs (HBG2, rs7482144; BCL11A, rs1427407 and rs10189857; and HBS1L-MYB intergenic region, rs28384513 and rs9399137) were investigated by multiplex PCR and reverse hybridization, and their roles in HbF and clinical phenotype variability in Iraqi Kurds with SCD were assessed. RESULTS HBG2 rs7482144 with minor allele frequency (MAF) of 0.133 was the most significant contributor to HbF variability, contributing 18.1%, followed by rs1427407 (MAF of 0.266) and rs9399137 (MAF of 0.137) at 14.3% and 8.8%, respectively. The other two SNPs were not significant contributors. Furthermore, when the cumulative numbers of minor alleles in the three contributing SNPs were assessed, HbF% and hemoglobin concentration increased with increasing number of minor alleles (P < 0.0005 and 0.001, respectively), while serum lactic dehydrogenase, reticulocytes, leukocytes, transfusion, and pain frequencies decreased (P = 0.003, 0.004, <0.0005, <0.0005, and 0.017, respectively). CONCLUSIONS It was demonstrated that SNPs in all three major HbF QTLs contribute significantly to HbF and clinical variability in Iraqi Kurds with SCD and that the cumulative number of minor alleles at contributing SNPs may serve as a better predictor of such variability in this population.
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Affiliation(s)
- Nasir Al-Allawi
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
| | | | | | - David H K Chui
- Departments of Medicine, Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - John J Farrell
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, Massachusetts
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Goonasekera H, Paththinige C, Dissanayake V. Population Screening for Hemoglobinopathies. Annu Rev Genomics Hum Genet 2018; 19:355-380. [DOI: 10.1146/annurev-genom-091416-035451] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hemoglobinopathies are the most common single-gene disorders in the world. Their prevalence is predicted to increase in the future, and low-income hemoglobinopathy-endemic regions need to manage most of the world's affected persons. International organizations, governments, and other stakeholders have initiated national or regional prevention programs in both endemic and nonendemic countries by performing population screening for α- and β-thalassemia, HbE disease, and sickle cell disease in neonates, adolescents, reproductive-age adults (preconceptionally or in the early antenatal period), and family members of diagnosed cases. The main aim of screening is to reduce the number of affected births and, in the case of sickle cell disease, reduce childhood morbidity and mortality. Screening strategies vary depending on the population group, but a few common screening test methods are universally used. We discuss the salient features of population-screening programs around the globe as well as current and proposed screening test methodologies.
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Affiliation(s)
- H.W. Goonasekera
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;, ,
| | - C.S. Paththinige
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;, ,
- Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - V.H.W. Dissanayake
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;, ,
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Rizk SH. Challenges to laboratory hematology practice: Egypt perspective. Int J Lab Hematol 2018; 40 Suppl 1:126-136. [PMID: 29741248 DOI: 10.1111/ijlh.12834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/29/2018] [Indexed: 12/01/2022]
Abstract
Laboratory hematology is an integral part of all clinical laboratories along the extensive healthcare facilities in Egypt. The aim of this review is to portrait the laboratory hematology practice in Egypt including its unique socioeconomic background, blood disease pattern, education and training, regulatory oversight, and the related challenges. Current practice varies widely between different parts of the healthcare system in terms of the range of tests, applied techniques, workforce experience, and quality of service. The national transfusion service (NBTS) in Egypt has been recently upgraded and standardized according to the World Health Organization (WHO) guidelines. Formal postgraduate education roughly follows the British system. Laboratory hematology specialization is achieved through 2-3 years masters' degree followed by 2-4 years doctorate degree in clinical pathology with training and research in hematology. Improvement of laboratory hematology education is recently undergoing a reform as a part of the modernization of higher education policy and following the standards developed by the National Quality Assurance and Accreditation Agency (NQAAA). Accreditation of medical laboratories is recently progressing with the development of the "Egyptian Accreditation Council" (EGAC) as the sole accreditation body system and training of assessors. Current laboratory system has many challenges, some are related to the inadequate system performance, and others are unique to laboratory hematology issues. The rapid technological advances and therapeutic innovations in hematology practice call for an adapting laboratory system with continuous upgrading.
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Affiliation(s)
- S H Rizk
- Department of Clinical Pathology, Cairo University, Egypt
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