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Mondal P, Lopez SP, Khokhar A, Snyder D, Kitch D, Veten A. The influence of body mass index on airway resistance in children with sickle cell disease: A longitudinal study based on impulse oscillometry. Respir Med 2024; 224:107564. [PMID: 38360190 DOI: 10.1016/j.rmed.2024.107564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 12/07/2023] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Impulse oscillometry (IOS) is an effective tool for assessing airway mechanics and diagnosing obstructive airway disease (OAD) in children with sickle cell disease (C-SCD). Obesity is known to be associated with OAD, and untreated OAD often leads to hypoxia-related complications in C-SCD. Considering the increasing prevalence of obesity in C-SCD, it is important to explore the influence of body mass index (BMI) on OAD in this disease population. METHODS A longitudinal retrospective chart review was conducted on 55 C-SCD (161 IOS observations) and 35 non-SCD asthmatic children (C-Asthma) (58 observations), primarily to investigate the association between BMI and airway resistance in C-SCD and C-Asthma. We conducted generalized linear mixed models (GLMM), adjusted for pharmacotherapies, to demonstrate the influence of BMI on total (R5), central (R20), and peripheral (R5-20) airway resistance and reactance (X5, resonant frequency (Fres)). We further compared age, BMI, and IOS indices between C-SCD and C-Asthma using the Mann-Whitney test. RESULTS Age and BMI were not statistically different between the two groups. In C-SCD, BMI was associated with R5 (GLMM t-statistics:3.75, 95%CI:1.01,3.27, p-value<0.001*) and R20 (t-statistics:4.01, 95%CI:1.04,1.15, p-value<0.001*), but not with R5-20 or airway reactance. In asthmatics, BMI was not associated with IOS estimates except Fres (t-statistics: 3.93, 95%CI: -0.06, -0.02, p-value<0.001*). C-SCD demonstrated higher airway resistances (R5 and R20) and reactance (Fres) compared to C-Asthma (Mann-Whitney: p-values<0.05). CONCLUSION BMI significantly influenced total and central airway resistance in C-SCD. While higher airway resistances reflected increased OAD in C-SCD than asthmatics, higher Fres perhaps indicated progressive pulmonary involvement in C-SCD.
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Affiliation(s)
- Pritish Mondal
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA.
| | | | - Arshjot Khokhar
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David Snyder
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Diane Kitch
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Ahmed Veten
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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Astles R, Liu Z, Gillespie SE, Lai KW, Maillis A, Morris CR, Lane PA, Krishnamurti L, Bakshi N. Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease. Pain Rep 2023; 8:e1084. [PMID: 37559677 PMCID: PMC10409410 DOI: 10.1097/pr9.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/09/2023] [Accepted: 04/29/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction/Objective Acute pain episodes are a major cause of health care utilization (HCU) in sickle cell disease (SCD), and adolescence is associated with increased pain frequency. We sought to determine whether there were differences in acute pain trajectories by sex and frequency of pain episodes among adolescents with SCD who presented to the emergency department (ED). Methods Retrospective review of electronic health records from a large, multicampus, pediatric SCD program. Results Of the 113 adolescents included, the mean age was 16.6 (SD 0.9), 41.6% (n = 47) were female, 77.9% (n = 88) had HbSS or a similarly severe genotype, and 43.4% (n = 49) had ≥3 episodes of HCU for pain, which we defined as having history of high HCU for pain. Those with a history of high HCU for pain had higher mean pain intensity scores at presentation, were more likely to receive either intravenous or intranasal opioids, and were more likely to be hospitalized. In a model considering the 3-way interaction between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score, adjusted for opioid per kilogram body weight, and prescription of hydroxyurea, adolescent female patients with high HCU for pain had the slowest decline in pain intensity during treatment for acute pain in the ED. Conclusion Sex and history of high HCU for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED. These novel findings should be confirmed in future prospective studies.
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Affiliation(s)
- Rachel Astles
- Emory University School of Medicine, Atlanta, GA, USA
| | - Zihao Liu
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Scott E. Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Kristina W. Lai
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Alexander Maillis
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Ibemere SO, Oyedeji CI, Preiss L, Van Althuis LE, Hankins JS, Azul M, Burns EN, Glassberg J, Hagar W, Hussain F, King A, Melvin C, Myers J, Snyder A, Shah N, Tanabe P. Characterising the prevalence of overweight and obese status among adults with sickle cell disease. Br J Haematol 2023; 200:633-642. [PMID: 36382420 PMCID: PMC9957798 DOI: 10.1111/bjh.18548] [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: 08/25/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
Individuals with sickle cell disease (SCD) have historically been considered underweight. Despite increasing body mass index (BMI) in the general population, the prevalence of overweight and obese status remains unclear in the adult SCD population. Our primary aim was to determine the prevalence of overweight and obese status and to identify associations between BMI, demographic, and clinical characteristics. We conducted an analysis of abstracted electronic health record data and patient-reported outcomes from the Sickle Cell Disease Implementation Consortium registry; individuals aged 20-45 years were included. The median (interquartile range) BMI for the 1664 adults in this analysis was 23.9 (21.1-28) kg/m2 . In this cohort, 42.9% had a BMI of >25 kg/m2 (Centers for Disease Control and Prevention definition of overweight/obese). In multivariable analysis, higher odds of being overweight or obese were associated with female gender, older age, college education, private insurance, and hypertension diagnosis. Higher odds of a BMI of >25 kg/m2 were observed in individuals with HbSC or HbSβ+ thalassaemia regardless of hydroxycarbamide (hydroxyurea) exposure (odds ratio [OR] 3.4, p < 0.0001) and HbSS or HbSβ0 thalassaemia exposed to hydroxycarbamide (OR 1.6, p = 0.0003) compared to those with HbSS or HbSβ0 thalassaemia with no hydroxycarbamide exposure. These data highlight the importance of early identification, prevention, and intervention for increasing BMI to reduce obesity-related complications that may impact SCD-related complications.
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Affiliation(s)
| | - Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Jane S Hankins
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melissa Azul
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ebony N Burns
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Ward Hagar
- University of California San Francisco, San Francisco, California, USA
| | - Faiz Hussain
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Allison King
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Myers
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Nirmish Shah
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke University Hospital, Durham, North Carolina, USA
| | - Paula Tanabe
- Duke University School of Nursing and Medicine, Durham, North Carolina, USA
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Jackson E, Karlson CW, Herring W, Okhomina VI, Lim CS, Morrow A, Daggett C, Arnold L, McNaull M. Prevalence of raised body mass index in paediatric sickle cell disease. J Paediatr Child Health 2022; 58:1829-1835. [PMID: 35822947 DOI: 10.1111/jpc.16118] [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: 10/14/2021] [Revised: 05/16/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
AIM Children with sickle cell disease (SCD) have historically weighed less than their healthy peers. More recently, a retrospective chart review from six institutions in New England reported nearly one-quarter of children and adolescents with SCD had raised body mass index (BMI). This study aimed to examine rates of children with SCD with raised BMI in Mississippi compared to state and national norms and assess the correlation between haemoglobin and BMI. METHODS A retrospective chart review of paediatric patients with SCD at the University of Mississippi Medical Center (UMMC) was conducted using data from the most recent clinic visit. Mississippi and national weight status estimates for youth 10-17 years were obtained from the 2016-2017 National Survey of Children's Health. RESULTS For youth 10-17 years with SCD (n = 345), 21.4.% of children with SS/Sβ° and 36.1% with SC/Sβ+ had raised BMI compared to Mississippi and national rates, 39.2 and 31%, respectively. The prevalence of children with raised BMI with SC/Sβ+ did not differ from state and national rates, while children with SS/Sβ° were half as likely as their Mississippi peers to have raised BMI. Haemoglobin levels were different among children with SCD who had low BMI (8.80 g/dL), average BMI (9.2 g/dL) and raised BMI (10.5 g/dL) (P < 0.001). CONCLUSIONS Children with SCD evaluated at UMMC have similar rates of raised BMI compared to state and national norms. Children with raised BMI have higher mean haemoglobin levels compared to children with SCD with low or average BMI. IMPLICATIONS AND CONTRIBUTION Historically, patients with SCD have been underweight and normal weight. Our paediatric and adolescent patients with SCD now have prevalence rates of raised BMI that approach state and national rates. Further work must be done to determine whether this reflects healthier children with SCD or raises concerns about life-style-related comorbidities.
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Affiliation(s)
- Erin Jackson
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Cynthia W Karlson
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Whitney Herring
- Mississippi Center for Advanced Medicine, Jackson, Mississippi, United States
| | - Victoria I Okhomina
- Department of Data Science, University of Mississippi Medical center, Jackson, Mississippi, United States
| | - Crystal S Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Anne Morrow
- Department of Psychology, Florida International University, Miami, Florida, United States.,College of Psychology, Nova Southeastern University, Fort Lauderdale, Florida, United States
| | - Caroline Daggett
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Laura Arnold
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Melissa McNaull
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
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Strong H, Harry O, Westcott E, Kidwell KM, Couch SC, Peairs A, Britto MT, Crosby LE. Weight status and health behaviors of adolescents and young adults with sickle cell disease: The emerging risk for obesity. Pediatr Hematol Oncol 2021; 38:265-271. [PMID: 33150822 PMCID: PMC9188326 DOI: 10.1080/08880018.2020.1838010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/03/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
Historically, youth with sickle cell disease (SCD) were at risk for being underweight, but recent data suggests this population is replicating obesity trends of youth in the United States. The current observational study assessed the weight status and health behaviors of 44 adolescents and young adults with SCD via a self-report survey and chart review. Using height and weight data closest to survey completion date, 27% of participants were either overweight or obese. With respect to obesogenic risk behaviors, 77% ate fast food 1-3 times per week, 25% had no fruits/vegetables with any of their meals, 11% drank no water, and 57% watched 4 or more hours of television per day. Though more research is needed, this preliminary study adds to the SCD literature suggesting an emerging shift toward obesity in this population. As such, adolescents with SCD may benefit from interventions to decrease obesity risk factors as being overweight or obese has the potential to worsen SCD-related symptoms and complications.
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Affiliation(s)
- Heather Strong
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, United States of America
| | - Onengiya Harry
- Section of Pediatric Rheumatology, Department of Pediatrics, Brenner Children’s Hospital, Winston-Salem, United States of America
| | - Emilie Westcott
- Clinical Nutrition Department, Dayton Children’s Hospital, Dayton, United States of America
| | - Katherine M. Kidwell
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, United States of America
| | - Sarah C. Couch
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, United States of America
| | - Abigail Peairs
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, United States of America
| | - Maria T. Britto
- James Anderson Center for Health Systems Excellence and Center for Innovation in Chronic Disease Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, United States of America
- Department of Pediatrics, University of Cincinnati, Cincinnati, United States of America
| | - Lori E. Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, United States of America
- Department of Pediatrics, University of Cincinnati, Cincinnati, United States of America
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Management of Sickle Cell Disease Pain among Adolescent and Pediatric Patients. Brain Sci 2019; 9:brainsci9080182. [PMID: 31366021 PMCID: PMC6721296 DOI: 10.3390/brainsci9080182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 12/03/2022] Open
Abstract
Management of sickle cell pain in adolescent and pediatric patients is inadequate, and the employment of proper management guidelines and practices are highly variable among different regions and populations. APPT, the multidimensional adolescent pediatric pain tool, promotes optimal pain management and introduces best practical guidelines for pain management. The goal of this study is to assess pain and pain management among young patients diagnosed with sickle cell disease (SCD) by introducing the APPT as a tool for pain management, and analyze factors contributing to pain management. Information relevant to demographic data, SCD characteristics, APPT assessment, and satisfaction of patients regarding pain management were collected using a structured questionnaire. Results showed that SCD is highly associated with gender (p = 0.022), consanguinity (p = 0.012), and number of surgeries (p = 0.013). Most patients (58.9%) indicated the involvement of more than six body areas affected during pain crisis. Severe pain was described by more than half the patients (55.6%), while moderate pain was reported by 31.1%. Most patients described their pain by sensory, affective, and temporal words. The number of painful areas, pain intensity, and use of descriptive pain words was correlated and interpreted by age, BMI, school absence, and number of surgeries. Results of this study could provide guidance to healthcare providers to improve current practices for SCD pain management in order to improve health outcomes and patients’ satisfaction.
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Sharma P, McCarty TR, Yadav S, Ngu JN, Njei B. Impact of Bariatric Surgery on Outcomes of Patients with Sickle Cell Disease: a Nationwide Inpatient Sample Analysis, 2004–2014. Obes Surg 2019; 29:1789-1796. [DOI: 10.1007/s11695-019-03780-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hall R, Gardner K, Rees DC, Chakravorty S. High body mass index in children with sickle cell disease: a retrospective single-centre audit. BMJ Paediatr Open 2018; 2:e000302. [PMID: 30397666 PMCID: PMC6202990 DOI: 10.1136/bmjpo-2018-000302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/15/2018] [Accepted: 09/12/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess the prevalence of high body mass index (BMI) in children with sickle cell disease and assess correlation between BMI and disease severity. DESIGN Retrospective chart review followed by statistical analysis. SETTING A single tertiary paediatric clinic in inner city London. PATIENTS All patients with sickle cell disease, including homozygous haemoglobin (HbSS) and compound heterozygous Hb (HbSC), age 2-18 years receiving clinical care at the centre, were included in the study. INTERVENTIONS Height and weight measurements, steady-state laboratory blood tests, hospital admission rates, adjunct therapy such as hydroxycarbamide or blood transfusions and obstructive sleep apnoea (OSA) data were obtained from the hospital electronic patient records. MAIN OUTCOME MEASURES To study the prevalence of high BMI and to identify any correlation between BMI and disease severity. RESULTS 385 patients were included. 64 children (17%) were overweight or obese, of which a significantly higher number of children with HbSC were obese or overweight (23 out of 91, 25%) compared with those with HbSS (36 out of 273, 13%), p≤0.001. No correlation was found between high BMI and presence of OSA, and markers of disease severity such as admission rates, fetal haemoglobin or lactate dehydrogenase levels. CONCLUSIONS High BMI did not correlate with disease severity in this cohort of patients with sickle cell disease. Obesity was more prevalent in females and those with HbSC. Further prospective studies are needed to determine long-term effects of BMI in disease severity and outcome.
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Affiliation(s)
- Rachael Hall
- Department of Haematology, Imperial College London, London, UK
| | - Kate Gardner
- Department of Haematological Medicine, King's College London, London, UK
| | - David C Rees
- Department of Haematological Medicine, King's College London, London, UK.,Department of Paediatric Haematology, King's College Hospital, London, UK
| | - Subarna Chakravorty
- Department of Haematological Medicine, King's College London, London, UK.,Department of Paediatric Haematology, King's College Hospital, London, UK
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Wonkam A, Mnika K, Ngo Bitoungui VJ, Chetcha Chemegni B, Chimusa ER, Dandara C, Kengne AP. Clinical and genetic factors are associated with pain and hospitalisation rates in sickle cell anaemia in Cameroon. Br J Haematol 2017; 180:134-146. [PMID: 29205277 DOI: 10.1111/bjh.15011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/17/2017] [Indexed: 12/11/2022]
Abstract
We aimed to investigate the clinical and genetic predictors of painful vaso-occlusive crises (VOC) in sickle cell disease (SCD) in Cameroon. Socio-demographics, clinical variables/events and haematological indices were acquired. Genotyping was performed for 40 variants in 17 pain-related genes, three fetal haemoglobin (HbF)-promoting loci, two kidney dysfunctions-related genes, and HBA1/HBA2 genes. Statistical models using regression frameworks were performed in R® . A total of 436 hydoxycarbamide- and opioid-naïve patients were studied; median age was 16 years. Female sex, body mass index, Hb/HbF, blood transfusions, leucocytosis and consultation or hospitalisation rates significantly correlated with VOC. Three pain-related genes variants correlated with VOC (CACNA2D3-rs6777055, P = 0·025; DRD2-rs4274224, P = 0·037; KCNS1-rs734784, P = 0·01). Five pain-related genes variants correlated with hospitalisation/consultation rates. (COMT-rs6269, P = 0·027; FAAH-rs4141964, P = 0·003; OPRM1-rs1799971, P = 0·031; ADRB2-rs1042713; P < 0·001; UGT2B7-rs7438135, P = 0·037). The 3·7 kb HBA1/HBA2 deletion correlated with increased VOC (P = 0·002). HbF-promoting loci variants correlated with decreased hospitalisation (BCL11A-rs4671393, P = 0·026; HBS1L-MYB-rs28384513, P = 0·01). APOL1 G1/G2 correlated with increased hospitalisation (P = 0·048). This first study from Africa has provided evidence supporting possible development of genetic risk model for pain in SCD.
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Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Khuthala Mnika
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | - Emile R Chimusa
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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