1
|
Meloni A, Saba L, Positano V, Pistoia L, Campanella A, Spasiano A, Putti MC, Fotzi I, Cossu A, Corigliano E, Massa A, Keilberg P, Cademartiri F, Cau R. Global longitudinal strain by cardiac magnetic resonance is associated with cardiac iron and complications in beta-thalassemia major patients. Int J Cardiol 2024; 413:132319. [PMID: 38971535 DOI: 10.1016/j.ijcard.2024.132319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/24/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The aim of this cross-sectional study was to investigate the association of left ventricular (LV) strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure and arrhythmias) in patients with β-thalassemia major (β-TM). METHOD We considered 266 β-TM patients (134 females, 37.08 ± 11.60 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project and 80 healthy controls (50 females, mean age 39.77 ± 11.29 years). The CMR protocol included cine images for the assessment of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) using feature tracking (FT) and for the quantification of LV function parameters, the T2* technique for the assessment of myocardial iron overload, and late gadolinium enhancement (LGE) technique. RESULTS In comparison to the healthy control group, β-TM patients showed impaired GLS, GCS, and GRS values. Among β-TM patients, sex was identified as the sole independent determinant of all LV strain parameters. All LV strain parameters displayed a significant correlation with LV end-diastolic volume index, end-systolic volume index, mass index, and ejection fraction, and with the number of segments exhibiting LGE. Only GLS exhibited a significant correlation with global heart T2* values and the number of segments with T2* < 20 ms. Patients with cardiac complications exhibited significantly impaired GLS compared to those without cardiac complications. CONCLUSION In patients with β-TM, GLS, GCS, and GRS were impaired in comparison with control subjects. Among LV strain parameters, only GLS demonstrated a significant association with cardiac iron levels and complications.
Collapse
Affiliation(s)
- Antonella Meloni
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| | - Vincenzo Positano
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; U.O.C. Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessandra Campanella
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Napoli, Italy
| | - Maria Caterina Putti
- Dipartimento della Salute della Donna e del Bambino, Clinica di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università di Padova, Padova, Italy
| | - Ilaria Fotzi
- SOC Oncologia, Ematologia e Trapianto di Cellule Staminali Emopoietiche, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Antonella Cossu
- Ambulatorio Trasfusionale - Servizio Immunoematologia e Medicina Trasfusionale Dipartimento dei Servizi, Presidio Ospedaliero "San Francesco", Nuoro, Italy
| | | | - Antonella Massa
- Servizio Trasfusionale, Ospedale "Giovanni Paolo II", Olbia, Italy
| | - Petra Keilberg
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
| | - Riccardo Cau
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| |
Collapse
|
2
|
Tuo Y, Li Y, Li Y, Ma J, Yang X, Wu S, Jin J, He Z. Global, regional, and national burden of thalassemia, 1990-2021: a systematic analysis for the global burden of disease study 2021. EClinicalMedicine 2024; 72:102619. [PMID: 38745964 PMCID: PMC11090906 DOI: 10.1016/j.eclinm.2024.102619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Background Anemia is a significant contributor to the global disease burden, of which thalassemia is the most common hereditary anaemic disease. Previous estimates were based on data that were geographically limited and lacked comprehensive global analysis. This study provides the prevalence, incidence, mortality and disability-adjusted life years (DALYs) of thalassemia in 204 countries and regions of thalassemia between 1990 and 2021, focusing on the age structure and time trends of the disease burden. To provide effective information for health policy, allocation of medical resources and optimization of patient management programs. Methods Using the standardised Global Burden of Disease (GBD) methodologies, we aimed to derive a more precise representation of the health burden posed by thalassemia by considering four distinct types of epidemiological data, namely the incidence at birth, prevalence, mortality and DALYs. The presented data were meticulously estimated and displayed both as numerical counts and as age-standardised rates per 100,000 persons of the population, accompanied by uncertainty interval (UI) to highlight potential statistical variability. The temporal trends spanning the years 1990-2021 were subjected to a rigorous examination utilizing Joinpoint regression analysis. This methodological approach facilitated the computation of the annual percentage change (APC) and the average annual percentage change (AAPC), along with their corresponding 95% confidence intervals (CIs). Findings Globally, the age-standardized prevalence rates (ASPR), age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALYs rates for thalassemia in 2021 were 18.28 per 100,000 persons (95% UI 15.29-22.02), 1.93 per 100,000 persons (95% UI 1.51-2.49), 0.15 per 100,000 persons(95% UI 0.11-0.20), and 11.65 per 100,000 persons (95% UI 8.24-14.94), respectively. Compared to 1990, these rates have decreased by 0.18 (95% UI -0.22 to -0.14), 0.25 (95% UI -0.30 to -0.19), 0.48 (95% UI -0.60 to -0.28), and 0.49 (95% UI -0.62 to -0.29) respectively. In 2021, the ASIR of thalassemia was highest in East Asia at 7.35 per 100,000 persons (95% UI 5.37-10.04), and ASMR was highest in Southeast Asia at 0.37 per 100,000 persons (95% UI 0.29-0.45).Gender comparisons showed negligible differences in disease burden, with the highest prevalence noted in children under five, decreasing with age. The global ASPR and ASMR declined from 1990 to 2021 overall, though an increasing trend in prevalence was found among the elderly. Joinpoint analysis revealed that the global ASPR increased between 2018 and 2021 (APC = 9.2%, 95% CI: 4.8%-13.8%, P < 0.001), ASIR decreased (APC = -7.68%, 95% CI: -10.88% to -4.36%, P < 0.001), and there was a significant rise in ASMR from 2019 to 2021 (APC = 4.8%, 95% CI: 0.1%-9.6%, P < 0.05). Trends in ASPR and ASMR varied across regions, with notable changes in South Asia. Interpretation The global burden of thalassemia, reflected in its prevalence, incidence, mortality, and DALYs, exhibits significant disparities. Geographic and demographic shifts in disease distribution have been observed from 1990 to 2021, with an overall decrease in burden, yet an increase in cases among the elderly population. Analysis of epidemiological trends over time highlights the influence of health policies and significant public health interventions on thalassemia outcomes. There data are crucial for healthcare professionals, policymakers, and researchers to refine and enhance management strategies, aiming to further mitigate thalassemia's global impact. Funding National Natural Science Foundation of China; Guizhou Province Science and Technology Project; Guizhou Province Science and Technology Foundation of Health Commission.
Collapse
Affiliation(s)
- Yuanyuan Tuo
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Yang Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, 300020, China
| | - Yan Li
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Jianjuan Ma
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Xiaoyan Yang
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Shasha Wu
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Jiao Jin
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Zhixu He
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine, Zunyi Medical University, Zuiyi, 563000, China
| |
Collapse
|
3
|
Liu Y, Fillebeen C, Forest A, Botta A, Varin TV, Marette A, Burelle Y, Des Rosiers C, Pantopoulos K, Sweeney G. Perturbations in lipid metabolism and gut microbiota composition precede cardiac dysfunction in a mouse model of thalassemia. FASEB J 2023; 37:e23257. [PMID: 37902616 DOI: 10.1096/fj.202301043r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/05/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023]
Abstract
Cardiomyopathy is a major complication of thalassemia, yet the precise underlying molecular mechanisms remain unclear. We examined whether altered lipid metabolism is an early driving factor in the development of cardiomyopathy using the Th3/+ mouse model of thalassemia. At age 20 weeks, male and female Th3/+ mice manifested anemia and iron overload; however, only males displayed metabolic defects and altered cardiac function. Untargeted lipidomics indicated that the circulating levels of 35 lipid species were significantly altered in Th3/+ mice compared to wild-type controls: triglycerides (TGs) with saturated fatty acids (FAs; TG42:0 and TG44:0) were elevated, while TGs with unsaturated FAs (TG(18:2_20:5_18:2 and TG54:8)) were reduced. Similarly, phosphatidylcholines (PCs) with long chain FAs (palmitic (16:0) or oleic (18:1)) were increased, while PCs with polyunsaturated FAs decreased. Circulating PC(16:0_14:0), GlcCer(d18:1/24:0) correlated significantly with iron overload and cardiac hypertrophy. 16S rRNA gene profiling revealed alterations in the intestinal microbiota of Th3/+ mice. Differentially abundant bacterial genera correlated with PC(39:6), PC(18:1_22:6), GlcCer(d18:1/24:1) and CE(14:0). These results provide new knowledge on perturbations in lipid metabolism and the gut microbiota of Th3/+ mice and identify specific factors which may represent early biomarkers or therapeutic targets to prevent development of cardiomyopathy in β-thalassemia.
Collapse
Affiliation(s)
- Ying Liu
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Carine Fillebeen
- Lady Davis Institute for Medical Research and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anik Forest
- Montreal Heart Institute Research Center, Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Amy Botta
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Thibault V Varin
- Department of Medicine, Heart and lung Institute, University of Laval, Quebec City, Quebec, Canada
| | - André Marette
- Department of Medicine, Heart and lung Institute, University of Laval, Quebec City, Quebec, Canada
| | - Yan Burelle
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Des Rosiers
- Montreal Heart Institute Research Center, Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Kostas Pantopoulos
- Lady Davis Institute for Medical Research and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gary Sweeney
- Department of Biology, York University, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Alhuthali HM, Ataya EF, Alsalmi A, Elmissbah TE, Alsharif KF, Alzahrani HA, Alsaiari AA, Allahyani M, Gharib AF, Qanash H, Elmasry HM, Hassanein DE. Molecular patterns of alpha-thalassemia in the kingdom of Saudi Arabia: identification of prevalent genotypes and regions with high incidence. Thromb J 2023; 21:115. [PMID: 37950286 PMCID: PMC10636822 DOI: 10.1186/s12959-023-00560-w] [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: 08/06/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Alpha-thalassemia (α-thalassemia) is one of the most common monogenic diseases in Saudi Arabia and is associated with significant morbidity. Premarital testing programs in Saudi Arabia reduce the burden of hemoglobinopathy disorders, and ongoing monitoring is required. We aimed to explore the molecular nature of α-globin genes and identify the most common genotypes and regions with a high risk of α-thalassemia in Saudi Arabia. METHODS This retrospective study was conducted between January 2021 and December 2022. Six hundred twenty-five samples from patients with microcytic hypochromic anemia in Saudi Arabia were analyzed using reverse dot blot hybridization (RDBH)-based multiplex-PCR, which screens for the known 21 mutations of α-globin genes. RESULTS Seven mutations in the α-globin gene were identified in 88.96% (556) patients. The most frequent abnormality of a-globin genes was -α3.7 (62.3%), followed by α2IVS1(-5nt) (20.7%) and α2 polyA-1 (α2T.Saudi) (14.1%). Interestingly, α2 polyA-2 (α2T.Turkish) was identified in Saudi and presented with -MED, causing Haemoglobin H disease. The incidence of α-thalassemia in Saudi Arabia's cities showed significant differences (P = 0.004). Jeddah City had the highest percentage of cases (25%), followed by Makkah (23%), Taif (13.3%), and Al-Ahassa (12.4%). CONCLUSION The study provides current knowledge about the molecular nature of α- thalassemia, highlights the common genotypes that could contribute to disease occurrence in the Saudi population, and sheds light on Saudi regions with a high incidence. It also recommends further studies in a larger population and with differently composed molecular assays to verify these findings.
Collapse
Affiliation(s)
- Hayaa M Alhuthali
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, PO Box 11099, Taif, 21944, Saudi Arabia.
| | - Eman F Ataya
- Basic sciences, College of Applied Medical Sciences, Albaha University, Albaha, 4781, Saudi Arabia
- Lecturer of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Alaa Alsalmi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, PO Box 11099, Taif, 21944, Saudi Arabia
| | - Triq E Elmissbah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, PO Box 11099, Taif, 21944, Saudi Arabia
| | - Khalaf F Alsharif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, PO Box 11099, Taif, 21944, Saudi Arabia
| | - Hind A Alzahrani
- Basic sciences, College of Applied Medical Sciences, Albaha University, Albaha, 4781, Saudi Arabia
| | - Ahad Amer Alsaiari
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, PO Box 11099, Taif, 21944, Saudi Arabia
| | - Mamdouh Allahyani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, PO Box 11099, Taif, 21944, Saudi Arabia
| | - Amal F Gharib
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, PO Box 11099, Taif, 21944, Saudi Arabia
| | - Husam Qanash
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha'il, Hail, 55476, Saudi Arabia
- Medical and Diagnostic Research Center, University of Ha'il, Hail, 55473, Saudi Arabia
| | - Heba M Elmasry
- Al Borg Medical laboratories, Al Borg Diagnostics, Jeddah, Saudi Arabia
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut, Egypt
| | - Doha Elsayed Hassanein
- Al Borg Medical laboratories, Al Borg Diagnostics, Jeddah, Saudi Arabia
- Misr University for Sciences and Technology, Clinical and Chemical Pathology Department, Cairo, Egypt
| |
Collapse
|
5
|
Xie D, Xiang Y, Wang A, Xiong L, Kong F, Liu Z, Wang H. The risk factors of adverse pregnancy outcome for pre-pregnancy couples in Hunan, China: A cross-sectional study based on population. Medicine (Baltimore) 2020; 99:e23094. [PMID: 33157982 PMCID: PMC7647632 DOI: 10.1097/md.0000000000023094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/05/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022] Open
Abstract
To identify the prevalence of chronic disease and behavior risk factors of adverse pregnancy outcome for pre-pregnancy couples in Hunan province, China.A retrospective study including cross-sectional datas from the Free Pre-pregnancy Health Check (FPHC) surveillance system of Hunan, China in 2019 was conducted. Microsoft Excel 2010 was used for preliminary data analysis. The fowllowing descriptive analysis, t-tests, and Chi-Squared tests were carried out using SPSS 25.0.Among 419,971 couples, 182,450 (21.72%) individuals were older than 35 years, 257,471(69.48%) couples planned to have a second or additional child and 114,892 (27.36%) individuals had a history of adverse pregnancy outcomes. The mean number of risk factors of adverse pregnancy outcome was higher in males than that in females (2.17 per male vs 1.92 per female). The prevalence/proportions of hypertension, increased psychological pressure, high alanine transaminase or creatinine, smoking, passive smoke exposure, alcohol use, and exposure to environmental risk factors were higher in males than that in females (2.43% vs 1.35%, 0.68% vs 0.54%, 12.80% vs 5.93%, 2.52% vs 1.47%, 27.70% vs 0.24%, 10.94% vs 3.58%, 15.62% vs 1.07%, and 1.46% vs 1.15%, respectively). The proportion of females with an abnormal cervix was 3.35%, and the proportion of males with abnormal wrapping was 1.90%. The prevalence/proportions of anemia and work-related pressure or social tensions were higher in females than that in males (5.53% vs 0.51%, 15.39% vs 13.61%, and 8.22% vs 7.88%, respectively).History of adverse pregnancy outcomes and age olderthan 35 years were important risk factors for pre-pregnancy couples in Hunan province. The mean number of risk factors was higher in males than that in females. Hypertension, increased psychological pressure, high alanine transaminase and creatinine levels, smoking, passive smoke exposure, alcohol use, and exposure to dangerous environmental factors were the major risk factors for males. Anemia, work-related pressure and social tensions were the major risk factors for females.
Collapse
Affiliation(s)
- Donghua Xie
- Department of Information Management
- NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital), 58 Xiangchun Road, Changsha, Hunan, China
| | - Yueyun Xiang
- Department of clinical laboratory, Maternal and Child Health Hospital of Hunan Province
| | | | | | | | - Zhiyu Liu
- Department of Information Management
| | - Hua Wang
- NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital), 58 Xiangchun Road, Changsha, Hunan, China
| |
Collapse
|
6
|
Al-Momen H, Jasim SK, Hassan QA, Ali HH. Relationship between liver iron concentration determined by R2-MRI, serum ferritin, and liver enzymes in patients with thalassemia intermedia. Blood Res 2018; 53:314-319. [PMID: 30588469 PMCID: PMC6300676 DOI: 10.5045/br.2018.53.4.314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 01/12/2023] Open
Abstract
Background Iron overload is a risk factor affecting all patients with thalassemia intermedia (TI). We aimed to determine whether there is a relationship of serum ferritin (SF) and alanine aminotransferase (ALT) with liver iron concentration (LIC) determined by R2 magnetic resonance imaging (R2-MRI), to estimate the most relevant degree of iron overload and best time to chelate in patients with TI. Methods In this cross-sectional study, 119 patients with TI (mean age years) were randomly selected and compared with 120 patients who had a diagnosis of thalassemia major (TM). Correlations of LIC, as determined by R2-MRI, with SF and ALT levels, were assessed in all participants. A P-value <0.05 was considered statistically significant. Results SF and LIC levels were lower in patients with TI than in those with TM; only ferritin values were significant. We found a statistically significant relationship between SF and LIC, with cut-off estimates of SF in patients with TI who had splenectomy and those who entered puberty spontaneously (916 and 940 ng/mL, respectively) with LIC >5 mg Fe/g dry weight (P<0.0001). A significant relationship was also found for patients with TI who had elevated ALT level (63.5 U/L), of 3.15 times the upper normal laboratory limit, using a cut-off for LIC ≥5 mg Fe/g dry weight. Conclusion We determined the cut-off values for ALT and SF indicating the best time to start iron chelation therapy in patients with TI, and found significant correlations among iron overload, SF, and ALT.
Collapse
Affiliation(s)
- Hayder Al-Momen
- Department of Pediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Shaymaa Kadhim Jasim
- Department of Obstetrics & Gynecology, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Qays Ahmed Hassan
- Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Hayder Hussein Ali
- Department of Endocrinology, Al-Elwiya Pediatric Teaching Hospital, Al-Rusafa Health Directorate, Baghdad, Iraq
| |
Collapse
|