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Alagbe AE, Corozolla W, Samejima Teixeira L, Peres Coelho R, Heuminski de Avila AM, Paro Costa PD, Fatima Sonati M, de Faria EC, Nunes Dos Santos MN. Meteorological parameters and hospitalizations of patients with sickle cell anemia: a 20-year retrospective study in Campinas, São Paulo, Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1430-1442. [PMID: 35917483 DOI: 10.1080/09603123.2022.2098258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
To investigate the influence of climate on hospitalizations of sickle cell anemia (SCA) adults and children, we analyzed the health and meteorological parameters from a metropolis (1999-2018). 1462 hospitalizations were coded for SCA patients in crisis (M:F = 715:747) and 1354 hospitalizations for SCA patients without crisis (M:F = 698:656) [age = 22.9 vs 15.2 years and duration of hospitalization (DoH) = 5.7 vs 4.4 days, respectively,]. More hospitalizations were for adults than children in crisis, and for children than adults without crisis. More children and adults were hospitalized in winter andspring than in summer and autumn Hospitalizations correlated positively with humidity (lag -5), maximum pressure (lag -2), mean pressure (lag -2), and thermal amplitude (lag -2), and negatively with maximum temperature (lag -3). DoH positively correlated with minimum temperature (lag -4). Understanding these complex associations would induce attitudinal/behavioral modifications among patients and their caregivers.
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Affiliation(s)
- Adekunle Emmanuel Alagbe
- Laboratory of Hemoglobinopathies, Department of Clinical Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Welington Corozolla
- Laboratory of Lipids, Center for Medicine and Experimental Surgery, Department of Clinical Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Liriam Samejima Teixeira
- Laboratory of Lipids, Center for Medicine and Experimental Surgery, Department of Clinical Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Raissa Peres Coelho
- Laboratory of Lipids, Center for Medicine and Experimental Surgery, Department of Clinical Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Ana Maria Heuminski de Avila
- Center for Meteorological and Climatic Research Applied to Agriculture (CEPAGRI), University of Campinas, Campinas, São Paulo, Brazil
| | - Paula Dornhofer Paro Costa
- Department of Computer Engineering and Automation (DCA), School of Electrical and Computer Engineering (FEEC), University of Campinas, Campinas, São Paulo, Brazil
| | - Maria Fatima Sonati
- Laboratory of Hemoglobinopathies, Department of Clinical Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Eliana Cotta de Faria
- Laboratory of Lipids, Center for Medicine and Experimental Surgery, Department of Clinical Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Magnun Nueldo Nunes Dos Santos
- Laboratory of Hemoglobinopathies, Department of Clinical Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Ehlers VL, Sadler KE, Stucky CL. Peripheral transient receptor potential vanilloid type 4 hypersensitivity contributes to chronic sickle cell disease pain. Pain 2023; 164:1874-1886. [PMID: 36897169 PMCID: PMC10363186 DOI: 10.1097/j.pain.0000000000002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/08/2022] [Indexed: 03/11/2023]
Abstract
ABSTRACT Debilitating pain affects the lives of patients with sickle cell disease (SCD). Current pain treatment for patients with SCD fail to completely resolve acute or chronic SCD pain. Previous research indicates that the cation channel transient receptor potential vanilloid type 4 (TRPV4) mediates peripheral hypersensitivity in various inflammatory and neuropathic pain conditions that may share similar pathophysiology with SCD, but this channel's role in chronic SCD pain remains unknown. Thus, the current experiments examined whether TRPV4 regulates hyperalgesia in transgenic mouse models of SCD. Acute blockade of TRPV4 alleviated evoked behavioral hypersensitivity to punctate, but not dynamic, mechanical stimuli in mice with SCD. TRPV4 blockade also reduced the mechanical sensitivity of small, but not large, dorsal root ganglia neurons from mice with SCD. Furthermore, keratinocytes from mice with SCD showed sensitized TRPV4-dependent calcium responses. These results shed new light on the role of TRPV4 in SCD chronic pain and are the first to suggest a role for epidermal keratinocytes in the heightened sensitivity observed in SCD.
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Affiliation(s)
- Vanessa L Ehlers
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States
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Guerzoni ME, Marchesi S, Palazzi G, Lodi M, Pinelli M, Venturelli D, Bigi E, Quaglia N, Corti P, Serra R, Colombatti R, Sainati L, Masera N, Colombo F, Barone A, Iughetti L. Environmental Factors in Northern Italy and Sickle Cell Disease Acute Complications: A Multicentric Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1478. [PMID: 36291415 PMCID: PMC9600492 DOI: 10.3390/children9101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Environmental factors seem to influence clinical manifestations of sickle cell disease (SCD), but few studies have shown consistent findings. We conducted a retrospective multicentric observational study to investigate the influence of environmental parameters on hospitalization for vaso-occlusive crises (VOC) or acute chest syndrome (ACS) in children with SCD. METHODS Hospital admissions were correlated with daily meteorological and air-quality data obtained from Environmental Regional Agencies in the period 2011-2015. The effect of different parameters was assessed on the day preceding the crisis up to ten days before. Statistical analysis was performed using a quasi-likelihood Poisson regression in a generalized linear model. RESULTS The risk of hospitalization was increased for low maximum temperature, low minimum relative humidity, and low atmospheric pressure and weakly for mean wind speed. The diurnal temperature range and temperature difference between two consecutive days were determined to be important causes of hospitalization. For air quality parameters, we found a correlation only for high levels of ozone and for low values at the tail corresponding to the lowest concentration of this pollutant. CONCLUSIONS Temperature, atmospheric pressure, humidity and ozone levels influence acute complications of SCD. Patients' education and the knowledge of the modes of actions of these factors could reduce hospitalizations.
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Affiliation(s)
- Maria Elena Guerzoni
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Stefano Marchesi
- Arpae-Agenzia Regionale per la Prevenzione, L’ambiente e L’energia dell’Emilia, Romagna, 41121 Modena, Italy
| | - Giovanni Palazzi
- Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Mariachiara Lodi
- Department of Medical and Surgical Sciences for Mothers, Child and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Margherita Pinelli
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Donatella Venturelli
- Department of Transfusion Medicine, University Hospital of Modena, 41124 Modena, Italy
| | - Elena Bigi
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Nadia Quaglia
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Paola Corti
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Roberta Serra
- Pediatric Onco-Hematology, Department of Pediatrics, University Hospital of Parma, 43126 Parma, Italy
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Nicoletta Masera
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Francesca Colombo
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Angelica Barone
- Pediatric Onco-Hematology, Department of Pediatrics, University Hospital of Parma, 43126 Parma, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Medical and Surgical Sciences for Mothers, Child and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy
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Determinants of severity in sickle cell disease. Blood Rev 2022; 56:100983. [PMID: 35750558 DOI: 10.1016/j.blre.2022.100983] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
Sickle cell disease is a very variable condition, with outcomes ranging from death in childhood to living relatively symptom free into the 8th decade. Much of this variability is unexplained. The co-inheritance of α thalassaemia and factors determining HbF levels significantly modify the phenotype, but few other significant genetic variants have been identified, despite extensive studies. Environmental factors are undoubtedly important, with socio-economics and access to basic medical care explaining the huge differences in outcomes between many low- and high-income countries. Exposure to cold and windy weather seems to precipitate acute complications in many people, although these effects are unpredictable and vary with geography. Many studies have tried to identify prognostic factors which can be used to predict outcomes, particularly when applied in infancy. Overall, low haemoglobin, low haemoglobin F percentage and high reticulocytes in childhood are associated with worse outcomes, although again these effects are fairly weak and inconsistent.
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Almuqamam M, Ahuja K, Wassef I, Kilaikode S, Sedrak A. Effect of Weather on Frequency of Vaso-Occlusive Crisis in Children With Sickle Cell Disease. Cureus 2021; 13:e17254. [PMID: 34540479 PMCID: PMC8445241 DOI: 10.7759/cureus.17254] [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] [Accepted: 08/16/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Sickle cell disease (SCD) is characterized by acute vaso-occlusive crisis (VOC) often manifested as painful episodes. Environmental factors are known to play a role in the frequency and severity of VOC. Methods The aim of this study is to analyze the relationship between weather changes and VOC in children with SCD. Data on daily temperature, humidity, and wind speed in Brooklyn, New York was collected over one year. Daily census data of children < 20 years of age with SCD presenting with VOC during the study period was retrieved from the Health Information Systems database. Data was analyzed to determine correlations of daily temperature, humidity, and wind speed with the number of VOCs using Pearson correlation co-efficient and time-series statistics. Results The total number of episodes of VOC was 344, with 218 outpatients and 126 inpatients. Total episodes of VOC peaked during January (n=44), while they were lowest in July (n=16). We observed a negative correlation of VOC with temperature (r= -0.05, p=0.04) and no correlation with humidity (r=0.01, p=0.85) was noted. Analysis of wind speed showed a negative correlation with VOC which is not significant. Conclusion No significant correlation was found between changes in humidity or wind speed and VOC. As this study was performed in an urban environment with extreme weather changes, results may be different in other geographic areas.
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Affiliation(s)
| | - Kanya Ahuja
- Pediatrics, The Brooklyn Hospital Center, Brooklyn, USA
| | - Inas Wassef
- Pediatrics, The Brooklyn Hospital Center, Brooklyn, USA
| | | | - Aziza Sedrak
- Pediatrics, The Brooklyn Hospital Center, Brooklyn, USA
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Cortabarria ASDV, Makhoul L, Strouboulis J, Lombardi G, Oteng-Ntim E, Shangaris P. In utero Therapy for the Treatment of Sickle Cell Disease: Taking Advantage of the Fetal Immune System. Front Cell Dev Biol 2021; 8:624477. [PMID: 33553164 PMCID: PMC7862553 DOI: 10.3389/fcell.2020.624477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/23/2020] [Indexed: 01/16/2023] Open
Abstract
Sickle Cell Disease (SCD) is an autosomal recessive disorder resulting from a β-globin gene missense mutation and is among the most prevalent severe monogenic disorders worldwide. Haematopoietic stem cell transplantation remains the only curative option for the disease, as most management options focus solely on symptom control. Progress in prenatal diagnosis and fetal therapeutic intervention raises the possibility of in utero treatment. SCD can be diagnosed prenatally in high-risk patients using chorionic villus sampling. Among the possible prenatal treatments, in utero stem cell transplantation (IUSCT) shows the most promise. IUSCT is a non-myeloablative, non-immunosuppressive alternative conferring various unique advantages and may also offer safer postnatal management. Fetal immunologic immaturity could allow engraftment of allogeneic cells before fetal immune system maturation, donor-specific tolerance and lifelong chimerism. In this review, we will discuss SCD, screening and current treatments. We will present the therapeutic rationale for IUSCT, examine the early experimental work and initial human experience, as well as consider primary barriers of clinically implementing IUSCT and the promising approaches to address them.
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Affiliation(s)
| | - Laura Makhoul
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - John Strouboulis
- School of Cancer & Pharmaceutical Sciences, Kings College London, London, United Kingdom
| | - Giovanna Lombardi
- School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Eugene Oteng-Ntim
- School of Life Course Sciences, Kings College London, London, United Kingdom
| | - Panicos Shangaris
- School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
- School of Life Course Sciences, Kings College London, London, United Kingdom
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Creary SE, Chisolm DJ, Wrona SK, Cooper JN. Opioid Prescription Filling Trends Among Children with Sickle Cell Disease After the Release of State-Issued Guidelines on Pain Management. PAIN MEDICINE 2020; 21:2583-2592. [PMID: 32142138 DOI: 10.1093/pm/pnaa002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the impact of Ohio's 2012, 2013, and 2016 opioid prescribing guidelines on opioid and nonsteroidal anti-inflammatory drug (NSAID) prescription filling and health care utilization for pain among children with sickle cell disease (SCD). DESIGN Quasi-experimental retrospective cohort study. SETTING Ohio Medicaid claims data from August 2011 to August 2016. SUBJECTS Medicaid beneficiaries under age 19 years with SCD. METHODS Interrupted time series analyses comparing population-level rates of opioids and NSAID prescriptions filled, standardized amounts of opioids dispensed, and acute health care utilization for pain before and after release of each guideline. RESULTS In our cohort of 1,505 children with SCD, there was a temporary but significant decrease in the opioid filling rate (-2.96 prescriptions per 100 children, P = 0.01) and in the amount of opioids dispensed (-31.39 milligram morphine equivalents per filled prescription, P < 0.001) after the 2013 guideline but a temporary but significant increase in the opioid filling rate (7.44 prescriptions per 100 children, P < 0.001) and in the amount of opioids dispensed (72.73 mg morphine equivalents per filled prescription, P < 0.001) after the 2016 guideline. The NSAID filling rate did not significantly change after any of the guidelines. Acute health care utilization rates for pain after the 2016 guideline were similar to those before the 2013 guideline (rate ratio = 1.04, P = 0.63). CONCLUSIONS Our results suggest that Ohio's 2013 and 2016 guidelines were associated with significant but nonsustained changes in opioid prescription filling among children with SCD. Additional studies are needed to confirm that opioid guidelines have a sustained impact on excessive opioid prescribing, filling, and misuse.
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Affiliation(s)
- Susan E Creary
- Division of Pediatric Hematology/Oncology/BMT, Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Deena J Chisolm
- Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Sharon K Wrona
- Department of Anesthesiology & Pain Medicine/Comprehensive Pain and Palliative Care Services Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
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Takaoka K, Cyril AC, Jinesh S, Radhakrishnan R. Mechanisms of pain in sickle cell disease. Br J Pain 2020; 15:213-220. [PMID: 34055342 DOI: 10.1177/2049463720920682] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives The hallmark of sickle cell disease (SCD) is acute and chronic pain, and the pain dominates the clinical characteristics of SCD patients. Although pharmacological treatments of SCD targeting the disease mechanisms have been improved, many SCD patients suffer from pain. To overcome the pain of the disease, there have been renewed requirements to understand the novel molecular mechanisms of the pain in SCD. Methods We concisely summarized the molecular mechanisms of SCD-related acute and chronic pain, focusing on potential drug targets to treat pain. Results Acute pain of SCD is caused by vaso-occulusive crisis (VOC), impaired oxygen supply or infarction-reperfusion tissue injuries. In VOC, inflammatory cytokines include tryptase activate nociceptors and transient receptor potential vanilloid type 1. In tissue injury, the secondary inflammatory response is triggered and causes further tissue injuries. Tissue injury generates cytokines and pain mediators including bradykinin, and they activate nociceptive afferent nerves and trigger pain. The main causes of chronic pain are from extended hyperalgesia after a VOC and central sensitization. Neuropathic pain could be due to central or peripheral nerve injury, and protein kinase C might be associated with the pain. In central sensitization, neuroplasticity in the brain and the activation of glial cells may be related with the pain. Discussion In this review, we summarized the molecular mechanisms of SCD-related acute and chronic pain. The novel treatments targeting the disease mechanisms would interrupt complications of SCD and reduce the pain of the SCD patients.
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Affiliation(s)
- Kensuke Takaoka
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Asha Caroline Cyril
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | | | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
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Blumberg AH, Ebelt ST, Liang D, Morris CR, Sarnat JA. Ambient air pollution and sickle cell disease-related emergency department visits in Atlanta, GA. ENVIRONMENTAL RESEARCH 2020; 184:109292. [PMID: 32179263 PMCID: PMC7847665 DOI: 10.1016/j.envres.2020.109292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited, autosomal recessive blood disorder, among the most prevalent genetic diseases, globally. While the genetic and hemolytic dynamics of SCD have been well-characterized, the etiology of SCD-related pathophysiological processes is unclear. Although limited, observational evidence suggests that environmental factors, including urban air pollution, may play a role. OBJECTIVES We assessed whether daily ambient air pollution concentrations are associated with corresponding emergency department (ED) visit counts for acute SCD exacerbations in Atlanta, Georgia, during a 9-year (2005-2013) period. We also examined heterogeneity in response by age and sex. METHODS ED visit data were from 41 hospitals in the 20-county Atlanta, GA area. Associations between daily air pollution levels for 8 urban air pollutants and counts of SCD related ED visits were estimated using Poisson generalized linear models. RESULTS We observed positive associations between pollutants generally indicative of traffic emissions and corresponding SCD ED visits [e.g., rate ratio of 1.022 (95% CI: 1.002, 1.043) per interquartile range increase in carbon monoxide]. Age stratified analyses indicated stronger associations with traffic pollutants among children (0-18 years), as compared to older age strata. Associations involving other pollutants, including ozone and particulate matter and for models of individuals >18 years old, were consistent a null hypothesis of no association. DISCUSSION This analysis represents the first North American study to examine acute risk among individuals with SCD to urban air pollution and provide evidence of urban air pollution, especially from traffic sources, as a trigger for acute exacerbations. These findings are consistent with a hypothesis that biological pathways, including several centrally associated with oxidative stress, may contribute towards enhanced susceptibility in individuals with SCD.
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Lam HCY, Huang Z, Liu S, Guo C, Goggins WB, Chan EYY. Personal Cold Protection Behaviour and Its Associated Factors in 2016/17 Cold Days in Hong Kong: A Two-Year Cohort Telephone Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051672. [PMID: 32143415 PMCID: PMC7084253 DOI: 10.3390/ijerph17051672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 12/22/2022]
Abstract
Background: Despite larger health burdens attributed to cold than heat, few studies have examined personal cold protection behaviours (PCPB). This study examined PCPB during cold waves and identified the associated factors in a subtropical city for those without central heating system. Methods: A cohort telephone survey was conducted in Hong Kong during a colder cold wave (2016) and a warmer cold wave (2017) among adults (≥15). Socio-demographic information, risk perception, self-reported adverse health effects and patterns of PCPB during cold waves were collected. Associated factors of PCPB in 2017 were identified using multiple logistic regression. Results: The cohort included 429 subjects. PCPB uptake rates were higher during the colder cold wave (p < 0.0005) except for ensuring indoor ventilation. Of the vulnerable groups, 63.7% had low self-perceived health risks. High risk perception, experience of adverse health effects during the 2016 cold wave, females and older groups were positive associated factors of PCPB in 2017 (p < 0.05). Conclusions: PCPB changed with self-risk perception. However vulnerable groups commonly underestimated their own risk. Indoor ventilation may be a concern during cold days in settings that are less prepared for cold weather. Targeted awareness-raising promotion for vulnerable groups and practical strategies for ensuring indoor ventilation are needed.
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Affiliation(s)
- Holly Ching Yu Lam
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK;
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; (Z.H.); (S.L.); (C.G.)
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong, China;
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; (Z.H.); (S.L.); (C.G.)
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong, China;
| | - Sida Liu
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; (Z.H.); (S.L.); (C.G.)
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong, China;
| | - Chunlan Guo
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; (Z.H.); (S.L.); (C.G.)
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong, China;
| | - William Bernard Goggins
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong, China;
| | - Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; (Z.H.); (S.L.); (C.G.)
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong, China;
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LF, UK
- Correspondence: ; Tel.: +852-2252-8411
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Luo S, Falls C, Karri J, Tunis MP, Abd-Elsayed A. Patient with Sickle Cell Disease. GUIDE TO THE INPATIENT PAIN CONSULT 2020:323-339. [DOI: 10.1007/978-3-030-40449-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Air Drep-A Retrospective Study Evaluating the Influence of Weather Conditions and Viral Epidemics on Vaso-Occlusive Crises in Patients with Sickle Cell Disease Living in French Guiana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152724. [PMID: 31370136 PMCID: PMC6695746 DOI: 10.3390/ijerph16152724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/17/2022]
Abstract
(1) Objectives: French Guiana is the French territory most affected by sickle cell disease (SCD). This study investigates the associations between different environmental factors relative to climate, infectious outbreaks, and emergency visits or weekly hospital admissions for vaso-occlusive crisis (VOC). The identification of risk factors would lead to better patient care and patient management, and more targeted prevention and therapeutic education for patients with SCD in French Guiana. (2) Methods: This study was performed using data collected from the medicalized information system and emergency medical records of Cayenne General Hospital, between 1 January 2010 and 31 December 2016. ARIMA models were used to investigate the potential impact of weather conditions and flu epidemics on VOC occurrence. (3) Results: During the study period, 1739 emergency visits were recorded among 384 patients, of which 856 (49.2%) resulted in hospitalization, 811 (46.6%) resulted in hospital discharge, and 72 (4.2%) in another orientation. Decreased temperature and decreased humidity were both independent factors associated with an increase of VOC cases (p = 0.0128 and p = 0.0004, respectively). When studying severe VOC (leading to hospitalization, with or without prior emergency visit), 2104 hospital admissions were recorded for 326 patients. The only factor associated with severe VOC, in the multivariate analysis, was flu epidemics (p = 0.0148). (4) Conclusions: This study shows a link between climate, flu epidemics, and VOC in French Guiana. Patient’s awareness of risks related to climate and flu epidemics should be encouraged, as home prevention measures can help avoid painful crises. Moreover, physicians should encourage patients to get immunized for influenza every year.
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Sickle Cell Disease and Infections in High- and Low-Income Countries. Mediterr J Hematol Infect Dis 2019; 11:e2019042. [PMID: 31308918 PMCID: PMC6613623 DOI: 10.4084/mjhid.2019.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/21/2019] [Indexed: 01/17/2023] Open
Abstract
Infections, especially pneumococcal septicemia, meningitis, and Salmonella osteomyelitis, are a major cause of morbidity and mortality in patients with sickle cell disease (SCD). SCD increased susceptibility to infection, while infection leads to SCD-specific pathophysiological changes. The risk of infectious complications is highest in children with a palpable spleen before six months of age. Functional splenectomy, the results of repeated splenic infarctions, appears to be a severe host-defense defect. Infection is the leading cause of death, particularly in less developed countries. Defective host-defense mechanisms enhance the risk of pneumococcal complications. Susceptibility to Salmonella infections can be explained at least in part by a similar mechanism. In high-income countries, the efficacy of the pneumococcal vaccine has been demonstrated in this disease. A decreased in infection incidence has been noted in SCD patients treated prophylactically with daily oral penicillin. Studies in low-income countries suggest the involvement of a different spectrum of etiological agents.
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Affiliation(s)
- Chunliang Xu
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research and Departments of Medicine and of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Paul S Frenette
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research and Departments of Medicine and of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, USA.
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15
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Sabrie M, Cannas G, Tazarourte K, Poutrel S, Connes P, Hot A, Renoux C, Fattoum J, Joly P. Drepa-Opia: A Pilot Study to Determine the Predictive Factors of Morphine Use and Consumption in Hospitalized Adult Patients with Sickle Cell Disease. Hemoglobin 2019; 42:217-224. [PMID: 30604640 DOI: 10.1080/03630269.2018.1529602] [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: 10/27/2022]
Abstract
The aim of this study was to evaluate the clinical, biological and genetic factors that could be associated with the use and dose of morphine during hospitalization for vaso-occlussive crisis (VOC) in adults with sickle cell disease. Ninety-nine hospitalizations for acute VOC (58 sickle cell disease patients aged 18 to 60 years, one to six hospitalizations each) were recorded; we investigated the associations between qualitative and quantitative opioid requirements and several biological, clinical, epidemiological and genetic parameters. Visual analog pain scale (VAS) was the only independent predictor of the qualitative need for morphine (mean value of 8.5 vs. 6.1 for the 77 hospitalizations that required morphine). A higher total administered morphine dose, which relates mainly to the overall crisis severity, was associated with a lower hemoglobin (Hb) level at entry. The mean daily morphine dose, which is more influenced by the individual sensitivity to morphine, was not influenced by the studied genetic parameters [sickle cell disease type, α-thalassemia (α-thal) status, UGT2B7 and ABCB1 genotypes] but a very slight negative association was found with the total bilirubin (BIL) level at entry. Our study demonstrated that physicians are often reluctant to prescribe morphine in sickle cell disease as a VAS of 6 corresponds to the usual threshold of administration in other instances. Total Hb at entry was also associated for the first time with higher total morphine consumption and could be used in a predictive VOC severity score. These results have to be confirmed and completed on larger cohorts.
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Affiliation(s)
- Marie Sabrie
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Giovanna Cannas
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France.,c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France
| | - Karim Tazarourte
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Solène Poutrel
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,e Institut Universitaire de France , Paris , France
| | - Arnaud Hot
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France
| | - Céline Renoux
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,f Laboratoire de Biochimie et Biologie Moléculaire Grand Est, Groupement Hospitalier Est, Hospices Civils de Lyon , Bron , France
| | - Jihane Fattoum
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Philippe Joly
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,f Laboratoire de Biochimie et Biologie Moléculaire Grand Est, Groupement Hospitalier Est, Hospices Civils de Lyon , Bron , France
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Sadler KE, Stucky CL. Neuronal transient receptor potential (TRP) channels and noxious sensory detection in sickle cell disease. Neurosci Lett 2018; 694:184-191. [PMID: 30508569 DOI: 10.1016/j.neulet.2018.11.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/21/2022]
Abstract
Pain is the leading cause for hospitalization in patients with sickle cell disease (SCD). While the characteristics of SCD pain can vary widely between patients and between phases of the disease (e.g. vasoocclusive crisis pain vs. chronic pain), similar neuronal mechanisms likely underlie the various aspects of nociceptive processing. In the peripheral nervous system, small unmyelinated C fibers and lightly-myelinated Aδ fibers detect and transmit noxious stimuli. Both classes of neurons express members of the transient receptor potential (TRP) family, a group of ligand gated ion-channels that are activated by thermal, chemical, and mechanical stimuli. Promiscuous TRP channel family members are activated by a wide range of stimuli, many of which are dysregulated in patients with SCD and transgenic SCD mouse models. In 2011, our lab published the first report of TRP channel contributions to rodent SCD pain. Since that time, additional basic and clinical research efforts have investigated the genetic and biochemical status of TRP channels in SCD, placing particular focus on TRPV1. This review will discuss these advances and highlight the clinical SCD presentations that have not yet been studied, but which may be mediated by TRP channel activity.
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Affiliation(s)
- Katelyn E Sadler
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States.
| | - Cheryl L Stucky
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States
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Kalpatthi R, Novelli EM. Measuring success: utility of biomarkers in sickle cell disease clinical trials and care. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:482-492. [PMID: 30504349 PMCID: PMC6246014 DOI: 10.1182/asheducation-2018.1.482] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Progress in the care of sickle cell disease (SCD) has been hampered by the extreme complexity of the SCD phenotype despite its monogenic inheritance. While epidemiological studies have identified clinical biomarkers of disease severity, with a few exceptions, these have not been routinely incorporated in clinical care algorithms. Furthermore, existing biomarkers have been poorly apt at providing objective parameters to diagnose sickle cell crisis, the hallmark, acute complication of SCD. The repercussions of these diagnostic limitations are reflected in suboptimal care and scarcity of adequate outcome measures for clinical research. Recent progress in molecular and imaging diagnostics has heralded a new era of personalized medicine in SCD. Precision medicine strategies are particularly timely, since molecular therapeutics are finally on the horizon. This chapter will summarize the existing evidence and promising data on biomarkers for clinical care and research in SCD.
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Affiliation(s)
- Ram Kalpatthi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, PA; and
| | - Enrico M. Novelli
- Division of Hematology/Oncology and UPMC Heart, Lung and Blood Vascular Medicine Institute, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Abstract
Sickle cell disease (SCD) is a group of inherited disorders caused by mutations in HBB, which encodes haemoglobin subunit β. The incidence is estimated to be between 300,000 and 400,000 neonates globally each year, the majority in sub-Saharan Africa. Haemoglobin molecules that include mutant sickle β-globin subunits can polymerize; erythrocytes that contain mostly haemoglobin polymers assume a sickled form and are prone to haemolysis. Other pathophysiological mechanisms that contribute to the SCD phenotype are vaso-occlusion and activation of the immune system. SCD is characterized by a remarkable phenotypic complexity. Common acute complications are acute pain events, acute chest syndrome and stroke; chronic complications (including chronic kidney disease) can damage all organs. Hydroxycarbamide, blood transfusions and haematopoietic stem cell transplantation can reduce the severity of the disease. Early diagnosis is crucial to improve survival, and universal newborn screening programmes have been implemented in some countries but are challenging in low-income, high-burden settings.
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Rankine-Mullings AE, Morrison-Levy N, Soares D, Aldred K, King L, Ali S, Knight-Madden JM, Wisdom-Phipps M, Adams RJ, Ware RE, Reid M. Transcranial Doppler velocity among Jamaican children with sickle cell anaemia: determining the significance of haematological values and nutrition. Br J Haematol 2018; 181:242-251. [PMID: 29504121 DOI: 10.1111/bjh.15162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Angela E. Rankine-Mullings
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Nadine Morrison-Levy
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Deanne Soares
- Tropical Metabolism Research Unit; Caribbean Institute for Health Research Institute; University of the West Indies; Kingston Jamaica
| | - Karen Aldred
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Lesley King
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Susanna Ali
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Jennifer M. Knight-Madden
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Margaret Wisdom-Phipps
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Robert J. Adams
- Neurology; College of Medicine; Medical University of South Carolina; Charleston SC USA
| | - Russell E. Ware
- Cincinnati Children's Hospital Medical Centre; Cincinnati OH USA
| | - Marvin Reid
- Tropical Metabolism Research Unit; Caribbean Institute for Health Research Institute; University of the West Indies; Kingston Jamaica
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Affiliation(s)
- Frédéric B Piel
- From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.)
| | - Martin H Steinberg
- From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.)
| | - David C Rees
- From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.)
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21
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Asnani MR, Knight Madden J, Reid M, Greene LG, Lyew-Ayee P. Socio-environmental exposures and health outcomes among persons with sickle cell disease. PLoS One 2017; 12:e0175260. [PMID: 28384224 PMCID: PMC5383275 DOI: 10.1371/journal.pone.0175260] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 03/22/2017] [Indexed: 01/18/2023] Open
Abstract
There is much variability in the expression of sickle cell disease (SCD) and recent works suggest that environmental and social factors may also influence this variability. This paper aims to use geographic information systems technology to examine the association between socio-environmental exposures and health outcomes in all persons who have attended or currently attend the Sickle Cell Unit in Jamaica. Rural patients presented for clinical care at older ages and had less annual visits to clinic. Persons travelled relatively long distances to seek SCD care and those travelling longer had less health maintenance visits. Urban patients had a higher prevalence of significant pain crises (69.4% vs. 55.8%, p value<0.001) and respiratory events (21.2% vs. 14%, p value<0.001). Prevalence of leg ulcers did not vary between rural and urban patients but was higher in males than in females. Females also had lower odds of having respiratory events but there was no sex difference in history of painful crises. Persons with more severe genotypes lived in higher poverty and travelled longer for healthcare services. Persons in areas with higher annual rainfall, higher mean temperatures and living farther from factories had less painful crises and respiratory events. The paper highlights a need for better access to healthcare services for Jamaicans with SCD especially in rural areas of the island. It also reports interesting associations between environmental climatic exposures and health outcomes.
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Affiliation(s)
- Monika R. Asnani
- Sickle Cell Unit, Caribbean Institute for Health Institute, The University of the West Indies, Mona, Kingston 7, Jamaica (W.I.)
| | - Jennifer Knight Madden
- Sickle Cell Unit, Caribbean Institute for Health Institute, The University of the West Indies, Mona, Kingston 7, Jamaica (W.I.)
| | - Marvin Reid
- Tropical Metabolism Research Unit, Caribbean Institute for Health Institute, The University of the West Indies, Mona, Kingston 7, Jamaica (W.I.)
| | - Lisa-Gaye Greene
- Mona GeoInformatics Institute, The University of the West Indies, Mona, Kingston 7, Jamaica (W.I.)
| | - Parris Lyew-Ayee
- Mona GeoInformatics Institute, The University of the West Indies, Mona, Kingston 7, Jamaica (W.I.)
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22
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Piel FB, Tewari S, Brousse V, Analitis A, Font A, Menzel S, Chakravorty S, Thein SL, Inusa B, Telfer P, de Montalembert M, Fuller GW, Katsouyanni K, Rees DC. Associations between environmental factors and hospital admissions for sickle cell disease. Haematologica 2016; 102:666-675. [PMID: 27909222 PMCID: PMC5395107 DOI: 10.3324/haematol.2016.154245] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/25/2016] [Indexed: 01/21/2023] Open
Abstract
Sickle cell disease is an increasing global health burden. This inherited disease is characterized by a remarkable phenotypic heterogeneity, which can only partly be explained by genetic factors. Environmental factors are likely to play an important role but studies of their impact on disease severity are limited and their results are often inconsistent. This study investigated associations between a range of environmental factors and hospital admissions of young patients with sickle cell disease in London and in Paris between 2008 and 2012. Specific analyses were conducted for subgroups of patients with different genotypes and for the main reasons for admissions. Generalized additive models and distributed lag non-linear models were used to assess the magnitude of the associations and to calculate relative risks. Some environmental factors significantly influence the numbers of hospital admissions of children with sickle cell disease, although the associations identified are complicated. Our study suggests that meteorological factors are more likely to be associated with hospital admissions for sickle cell disease than air pollutants. It confirms previous reports of risks associated with wind speed (risk ratio: 1.06/standard deviation; 95% confidence interval: 1.00–1.12) and also with rainfall (1.06/standard deviation; 95% confidence interval: 1.01–1.12). Maximum atmospheric pressure was found to be a protective factor (0.93/standard deviation; 95% confidence interval: 0.88–0.99). Weak or no associations were found with temperature. Divergent associations were identified for different genotypes or reasons for admissions, which could partly explain the lack of consistency in earlier studies. Advice to patients with sickle cell disease usually includes avoiding a range of environmental conditions that are believed to trigger acute complications, including extreme temperatures and high altitudes. Scientific evidence to support such advice is limited and sometimes confusing. This study shows that environmental factors do explain some of the variations in rates of admission to hospital with acute symptoms in sickle cell disease, but the associations are complex, and likely to be specific to different environments and the individual’s exposure to them. Furthermore, this study highlights the need for prospective studies with large numbers of patients and standardized protocols across Europe.
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Affiliation(s)
- Frédéric B Piel
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, UK .,Department of Zoology, University of Oxford, UK
| | - Sanjay Tewari
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, UK
| | - Valentine Brousse
- Reference Centre for Sickle-Cell Disease, Pediatric Department, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, Université Paris Descartes, France
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Anna Font
- Environmental Research Group, MRC-PHE Centre for Environment and Health, King's College London, UK
| | - Stephan Menzel
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, UK
| | - Subarna Chakravorty
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, UK
| | - Swee Lay Thein
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, UK.,National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baba Inusa
- Department of Paediatric Haematology, Evelina Children's Hospital, King's College London, UK
| | - Paul Telfer
- Department of Paediatric Haematology and Oncology, Barts Health NHS Trust, Royal London Hospital, UK
| | - Mariane de Montalembert
- Reference Centre for Sickle-Cell Disease, Pediatric Department, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, Université Paris Descartes, France
| | - Gary W Fuller
- Environmental Research Group, MRC-PHE Centre for Environment and Health, King's College London, UK
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.,Environmental Research Group, MRC-PHE Centre for Environment and Health, King's College London, UK
| | - David C Rees
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, UK
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Shulman BS, Marcano AI, Davidovitch RI, Karia R, Egol KA. Nature's wrath-The effect of weather on pain following orthopaedic trauma. Injury 2016; 47:1841-6. [PMID: 27318614 DOI: 10.1016/j.injury.2016.05.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/29/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite frequent complaints by orthopaedic trauma patients, to our knowledge there is no data regarding weather's effect on pain and function following acute and chronic fracture. The aim of our study was to investigate the influence of daily weather conditions on patient reported pain and functional status. METHODS We retrospectively examined prospectively collected data from 2369 separate outpatient visits of patients recovering from operative management of acute tibial plateau fractures, acute distal radius fractures, and chronic fracture nonunions. Pain and functional status were assessed using a visual analogue scale (VAS) and the DASH and SMFA functional indexes. For each visit date, the mean temperature, difference between mean temperature and expected temperature, dew point, mean humidity, amount of rain, amount of snow, and barometric pressure were recorded. Statistical analysis was run to search for associations between weather data and patient reported pain and function. RESULTS Low barometric pressure was associated with increased pain across all patient visits (p=0.007) and for patients at 1-year follow-up only (p=0.005). At 1-year follow-up, high temperature (p=0.021) and high humidity (p=0.030) were also associated with increased pain. No significant association was noted between weather data and patient reported functional status at any follow-up interval. CONCLUSIONS Patient complaints of weather influencing pain after orthopaedic trauma are valid. While pain in the immediate postoperative period is most likely dominated by incisional and soft tissue injuries, as time progresses barometric pressure, temperature, and humidity impact patient pain levels. Affirming and counseling that pain may vary based on changing weather conditions can help manage patient expectations and improve satisfaction.
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Affiliation(s)
- Brandon S Shulman
- NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
| | - Alejandro I Marcano
- NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
| | - Roy I Davidovitch
- Center for Musculoskeletal Care, 33 East 38th Street, New York, NY 10016, USA.
| | - Raj Karia
- NYU Langone Medical Center, 380 2nd Ave. Suite 606, New York, NY 10010, USA.
| | - Kenneth A Egol
- NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
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24
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Braga JAP, Veríssimo MPDA, Saad STO, Cançado RD, Loggetto SR. Guidelines on neonatal screening and painful vaso-occlusive crisis in sickle cell disease: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular: Project guidelines: Associação Médica Brasileira - 2016. Rev Bras Hematol Hemoter 2016; 38:147-57. [PMID: 27208574 PMCID: PMC4877615 DOI: 10.1016/j.bjhh.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/04/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | - Rodolfo Delfini Cançado
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil; Hospital Samaritano, São Paulo, SP, Brazil
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25
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Sadreameli SC, Eakin MN, Robinson KT, Alade RO, Strouse JJ. Secondhand smoke is associated with more frequent hospitalizations in children with sickle cell disease. Am J Hematol 2016; 91:313-7. [PMID: 26690323 DOI: 10.1002/ajh.24281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 02/02/2023]
Abstract
Tobacco smoke exposure has been associated with more frequent hospitalizations in children with sickle cell disease (SCD), but previous studies have not quantified the exposure by objective methods. We enrolled 50 children and young adults with SCD in a retrospective and prospective cohort study and quantified tobacco smoke exposure by objective (salivary cotinine) and survey measures. We used a multivariable negative binomial regression model to evaluate the association between salivary cotinine and hospital admissions. Forty-five percent (22/49) of participants had significant elevation of salivary cotinine (≥ 0.5 ng/ml). The incidence risk ratio (IRR) for hospital admission for those with elevated cotinine was 3.7 (95% CI 1.8-8). Those exposed to secondhand smoke but not primary smokers (cotinine between 0.5 and 10 ng/ml) had a similarly increased risk of hospitalization [IRR 4.3 (95% CI 1.8-10)]. We show that an objective measure of tobacco smoke exposure, salivary cotinine, is strongly associated with the rate of hospital admissions in children and young adults with SCD. This association underscores the importance of screening for tobacco smoke exposure in people with SCD. Further investigation is warranted to determine the mechanisms of and to evaluate interventions to decrease tobacco smoke exposure.
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Affiliation(s)
- S. Christy Sadreameli
- Division of Pediatric Pulmonology, Department of Pediatrics; Johns Hopkins University; Baltimore Maryland
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine; Johns Hopkins University; Baltimore Maryland
| | - Kayin T. Robinson
- Division of Pediatric Hematology, Department of Pediatrics; Johns Hopkins University; Baltimore Maryland
| | - Rachel O. Alade
- Division of Pediatric Hematology, Department of Pediatrics; Johns Hopkins University; Baltimore Maryland
| | - John J. Strouse
- Division of Pediatric Hematology, Department of Pediatrics; Johns Hopkins University; Baltimore Maryland
- Division of Hematology, Department of Medicine; Johns Hopkins University; Baltimore Maryland
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26
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Cataldo G, Rajput S, Gupta K, Simone DA. Sensitization of nociceptive spinal neurons contributes to pain in a transgenic model of sickle cell disease. Pain 2015; 156:722-730. [PMID: 25630029 DOI: 10.1097/j.pain.0000000000000104] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic pain is a major characteristic feature of sickle cell disease (SCD). The refractory nature of pain and the development of chronic pain syndromes in many patients with SCD suggest that central neural mechanisms contribute to pain in this disease. We used HbSS-BERK sickle mice, which show chronic features of pain similar to those observed in SCD, and determined whether sensitization of nociceptive neurons in the spinal cord contributes to pain and hyperalgesia in SCD. Electrophysiological recordings of action potential activity were obtained from single identified dorsal horn neurons of the spinal cord in anesthetized mice. Compared with control HbAA-BERK mice, nociceptive dorsal horn neurons in sickle mice exhibited enhanced excitability as evidenced by enlarged receptive fields, increased rate of spontaneous activity, lower mechanical thresholds, enhanced responses to mechanical stimuli, and prolonged afterdischarges following mechanical stimulation. These changes were accompanied by increased phosphorylation of mitogen-activated protein kinases (MAPKs) in the spinal cord that are known to contribute to neuronal hyperexcitability, including c-Jun N-terminal kinase (JNK), p44/p42 extracellular signaling-regulated kinase (ERK), and p38. These findings demonstrate that central sensitization contributes to pain in SCD.
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Affiliation(s)
- Giuseppe Cataldo
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN, USA
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Tewari S, Brousse V, Piel FB, Menzel S, Rees DC. Environmental determinants of severity in sickle cell disease. Haematologica 2015; 100:1108-16. [PMID: 26341524 PMCID: PMC4800688 DOI: 10.3324/haematol.2014.120030] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/05/2015] [Indexed: 12/13/2022] Open
Abstract
Sickle cell disease causes acute and chronic illness, and median life expectancy is reduced by at least 30 years in all countries, with greater reductions in low-income countries. There is a wide spectrum of severity, with some patients having no symptoms and others suffering frequent, life-changing complications. Much of this variability is unexplained, despite increasingly sophisticated genetic studies. Environmental factors, including climate, air quality, socio-economics, exercise and infection, are likely to be important, as demonstrated by the stark differences in outcomes between patients in Africa and USA/Europe. The effects of weather vary with geography, although most studies show that exposure to cold or wind increases hospital attendance with acute pain. Most of the different air pollutants are closely intercorrelated, and increasing overall levels seem to correlate with increased hospital attendance, although higher concentrations of atmospheric carbon monoxide may offer some benefit for patients with sickle cell disease. Exercise causes some adverse physiological changes, although this may be off-set by improvements in cardiovascular health. Most sickle cell disease patients live in low-income countries and socioeconomic factors are undoubtedly important, but little studied beyond documenting that sickle cell disease is associated with decreases in some measures of social status. Infections cause many of the differences in outcomes seen across the world, but again these effects are relatively poorly understood. All the above factors are likely to account for much of the pathology and variability of sickle cell disease, and large prospective studies are needed to understand these effects better.
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Affiliation(s)
- Sanjay Tewari
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
| | - Valentine Brousse
- Reference Centre for Sickle Cell Disease, Pediatric Department, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris; Université Paris Descartes, France
| | | | - Stephan Menzel
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
| | - David C Rees
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
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Mekontso Dessap A, Contou D, Dandine-Roulland C, Hemery F, Habibi A, Charles-Nelson A, Galacteros F, Brun-Buisson C, Maitre B, Katsahian S. Environmental influences on daily emergency admissions in sickle-cell disease patients. Medicine (Baltimore) 2014; 93:e280. [PMID: 25546672 PMCID: PMC4602624 DOI: 10.1097/md.0000000000000280] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Previous reports have suggested a role for weather conditions and air pollution on the variability of sickle cell disease (SCD) severity, but large-scale comprehensive epidemiological studies are lacking. In order to evaluate the influence of air pollution and climatic factors on emergency hospital admissions (EHA) in SCD patients, we conducted an 8-year observational retrospective study in 22 French university hospitals in Paris conurbation, using distributed lag non-linear models, a methodology able to flexibly describe simultaneously non-linear and delayed associations, with a multivariable approach. During the 2922 days of the study, there were 17,710 EHA, with a mean daily number of 6.1 ± 2.8. Most environmental factors were significantly correlated to each other. The risk of EHA was significantly associated with higher values of nitrogen dioxide, atmospheric particulate matters, and daily mean wind speed; and with lower values of carbon monoxide, ozone, sulfur dioxide, daily temperature (minimal, maximal, mean, and range), day-to-day mean temperature change, daily bright sunshine, and occurrence of storm. There was a lag effect for 12 of 15 environmental factors influencing hospitalization rate. Multivariate analysis identified carbon monoxide, day-to-day temperature change, and mean wind speed, along with calendar factors (weekend, summer season, and year) as independent factors associated with EHA. In conclusion, most weather conditions and air pollutants assessed were correlated to each other and influenced the rate of EHA in SCD patients. In multivariate analysis, lower carbon monoxide concentrations, day-to-day mean temperature drop and higher wind speed were associated with increased risk of EHA.
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Affiliation(s)
- Armand Mekontso Dessap
- From the AP-HP, Hôpital H. Mondor - A. Chenevier, Service de Réanimation Médicale, CARMAS research group (AMD, DC, CB-B); Université Paris Est, Faculté de médecine (AMD, DC, FG, CB-B, BM); Inserm, U955, Equipe 8 (AMD, BM); AP-HP, Hôpital H. Mondor - A. Chenevier, Unité de Recherche Clinique (CD-R, AC-N, SK); AP-HP, Hôpital H. Mondor - A. Chenevier, Service d'Information Médicale (FH); AP-HP, Hôpital H. Mondor - A. Chenevier, Unité des Maladies du Globule Rouge (AH, FG); and AP-HP, Hôpital H. Mondor - A. Chenevier, Unité de Pneumologie, Créteil 94000, France (BM); AP-HP, Hôpital Européen Georges Pompidou (SK); Inserm UMRS1138, Centre de Recherche des Cordeliers, Equipe 22, Université Paris Descartes (SK)
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To begin at the beginning: sickle cell disease in Africa. LANCET HAEMATOLOGY 2014; 1:e50-1. [PMID: 27030152 DOI: 10.1016/s2352-3026(14)00006-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 11/20/2022]
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Kenyon N, Wang L, Spornick N, Khaibullina A, Almeida LE, Cheng Y, Wang J, Guptill V, Finkel JC, Quezado ZMN. Sickle cell disease in mice is associated with sensitization of sensory nerve fibers. Exp Biol Med (Maywood) 2014; 240:87-98. [PMID: 25070860 DOI: 10.1177/1535370214544275] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The pain phenotype in sickle cell disease (SCD) patients is highly variable. A small percentage of SCD patients experience many vaso-occlusive crises/year, 5% of patients account for over 30% of pain episodes, while 39% report few episodes of severe pain. Clearly, a better understanding of the pathobiology of SCD is needed to improve its therapy. Humanized sickle cell mice recapitulate several phenotypes of SCD patients and provide a model for the study of SCD pain. Researchers have shown that one strain of humanized SCD mice, the BERK strain, has abnormal pain phenotype. However, the nociception phenotype of another humanized SCD mouse strain, the Townes strain, has not been described. In a large cross-sectional study of BERK and Townes SCD mice, we examined thermosensory response and sensory nerve fiber function using sine-wave electrical stimulation at 2000, 250, and 5 Hz to stimulate preferentially Aβ, Aδ, and C sensory nerve fibers, respectively. We found that BERK and Townes mice, compared to respective controls, had decreases in 2000, 250, and 5 Hz current vocalization thresholds in patterns that suggest sensitization of a broad spectrum of sensory nerve fibers. In addition, the pattern of sensitization of sensory fibers varied according to strain, sex, age, and mouse genotype. In a similarly variable pattern, Townes and BERKs also had significantly altered sensitivity to noxious thermal stimuli in agreement with what has been shown by others. In summary, the analysis of somatosensory function using sine-wave electrical stimulation in humanized sickle cell mice suggests that in SCD, both myelinated and unmyelinated, fibers are sensitized. The pattern of sensory fiber sensitization is distinct from that observed in pain models of neuropathic and inflammatory pain. These findings raise the possibility that sensitization of a broad spectrum of sensory fibers might contribute to the altered and variable nociception phenotype in SCD.
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Affiliation(s)
- Nicholas Kenyon
- Children's Research Institute, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Medical Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20010, USA
| | - Li Wang
- Children's Research Institute, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Medical Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20010, USA
| | - Nicholas Spornick
- Children's Research Institute, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Medical Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20010, USA
| | - Alfia Khaibullina
- Children's Research Institute, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Medical Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20010, USA
| | - Luis Ef Almeida
- Children's Research Institute, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Medical Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20010, USA
| | - Yao Cheng
- Division of Biostatistics and Study Methodology, Center for Translational Science, Children's National Medical Center, Washington, DC 20010, USA
| | - Jichuan Wang
- Division of Biostatistics and Study Methodology, Center for Translational Science, Children's National Medical Center, Washington, DC 20010, USA
| | - Virginia Guptill
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
| | - Julia C Finkel
- Children's Research Institute, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Medical Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20010, USA
| | - Zenaide M N Quezado
- Children's Research Institute, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Medical Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20010, USA
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Affiliation(s)
- Valentine Brousse
- Department of Pediatrics, Reference Centre for Sickle Cell Disease, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
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Howard J, Thomas VJ, Rawle HM. Pain management and quality of life in sickle cell disease. Expert Rev Pharmacoecon Outcomes Res 2014; 9:347-52. [DOI: 10.1586/erp.09.32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sickle cell mice exhibit mechanical allodynia and enhanced responsiveness in light touch cutaneous mechanoreceptors. Mol Pain 2012; 8:62. [PMID: 22963123 PMCID: PMC3495672 DOI: 10.1186/1744-8069-8-62] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 07/24/2012] [Indexed: 11/10/2022] Open
Abstract
Background Sickle cell disease (SCD) is associated with both acute vaso-occlusive painful events as well as chronic pain syndromes, including heightened sensitivity to touch. We have previously shown that mice with severe SCD (HbSS mice; express 100% human sickle hemoglobin in red blood cells; RBCs) have sensitized nociceptors, which contribute to increased mechanical sensitivity. Yet, the hypersensitivity in these neural populations alone may not fully explain the mechanical allodynia phenotype in mouse and humans. Findings Using the Light Touch Behavioral Assay, we found HbSS mice exhibited increased responses to repeated application of both innocuous punctate and dynamic force compared to control HbAA mice (100% normal human hemoglobin). HbSS mice exhibited a 2-fold increase in percent response to a 0.7mN von Frey monofilament when compared to control HbAA mice. Moreover, HbSS mice exhibited a 1.7-fold increase in percent response to the dynamic light touch “puffed” cotton swab stimulus. We further investigated the mechanisms that drive this behavioral phenotype by focusing on the cutaneous sensory neurons that primarily transduce innocuous, light touch. Low threshold cutaneous afferents from HbSS mice exhibited sensitization to mechanical stimuli that manifested as an increase in the number of evoked action potentials to suprathreshold force. Rapidly adapting (RA) Aβ and Aδ D-hair fibers showed the greatest sensitization, each with a 75% increase in suprathreshold firing compared to controls. Slowly adapting (SA) Aβ afferents had a 25% increase in suprathreshold firing compared to HbAA controls. Conclusions These novel findings demonstrate mice with severe SCD exhibit mechanical allodynia to both punctate and dynamic light touch and suggest that this behavioral phenotype may be mediated in part by the sensitization of light touch cutaneous afferent fibers to suprathreshold force. These findings indicate that Aβ fibers can be sensitized to mechanical force and should potentially be examined for sensitization in other tissue injury and disease models.
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Ballas SK, Kesen MR, Goldberg MF, Lutty GA, Dampier C, Osunkwo I, Wang WC, Hoppe C, Hagar W, Darbari DS, Malik P. Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management. ScientificWorldJournal 2012; 2012:949535. [PMID: 22924029 PMCID: PMC3415156 DOI: 10.1100/2012/949535] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/01/2012] [Indexed: 12/25/2022] Open
Abstract
The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation and Department of Medicine, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
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Pediatric Vasoocclusive Crisis and Weather Conditions. J Emerg Med 2011; 41:559-65. [DOI: 10.1016/j.jemermed.2010.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/28/2009] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
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Molokie RE, Wang ZJ, Wilkie DJ. Presence of neuropathic pain as an underlying mechanism for pain associated with cold weather in patients with sickle cell disease. Med Hypotheses 2011; 77:491-3. [PMID: 21763079 DOI: 10.1016/j.mehy.2011.06.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 06/05/2011] [Indexed: 01/01/2023]
Abstract
Less than 20 years after Herrick described the first case, the cold was proposed as having a role in precipitating pain in sickle cell disease. Numerous publications focus on weather changes, in particular exposure to the cold, and their association with vaso-occlusive (painful) episodes. Whereas several theories have been proposed to explain the association, a plausible hypothesis based on our current understanding of the pathophysiology of pain has not been offered. We hypothesize that the pain evoked by these weather changes are allodyinic (pain with stimulus not typically painful) and hyperalgesic (heightened pain with painful stimulus) responses due to the presence of neuropathic pain. This hypothesis represents a paradigm shift in understanding, as well as explaining at least some of the pain experience in sickle cell disease, and should be the impetus to further determine the characteristics of those patients who develop allodynia and hyperalgesia to cold weather. Whereas some researchers have suggested that those with sickle cell disease may have neuropathic pain, including a report from our own ongoing study [1], it has not been well accepted nor has it been applied in understanding pain associated with sickle cell disease. The conceptual shift and new understanding is important to develop preventive strategies, apply pain therapies new to the sickle cell population, and view pain in sickle cell disease in the context of a chronic disease.
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Affiliation(s)
- R E Molokie
- College of Pharmacy, Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, IL, United States.
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Transient receptor potential vanilloid 1 mediates pain in mice with severe sickle cell disease. Blood 2011; 118:3376-83. [PMID: 21708890 DOI: 10.1182/blood-2010-12-327429] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Pain is the leading cause of emergency department visits, hospitalizations, and daily suffering in individuals with sickle cell disease (SCD). The pathologic mechanisms leading to the perception of pain during acute RBC sickling episodes and development of chronic pain remain poorly understood and ineffectively treated. We provide the first study that explores nociceptor sensitization mechanisms that contribute to pain behavior in mice with severe SCD. Sickle mice exhibit robust behavioral hypersensitivity to mechanical, cold, and heat stimuli. Mechanical hypersensitivity is further exacerbated when hypoxia is used to induce acute sickling. Behavioral mechanical hypersensitivity is mediated in part by enhanced excitability to mechanical stimuli at both primary afferent peripheral terminal and sensory membrane levels. In the present study, inhibition of the capsaicin receptor transient receptor potential vanilloid 1 (TRPV1) with the selective antagonist A-425619 reversed the mechanical sensitization at both primary afferent terminals and isolated somata, and markedly attenuated mechanical behavioral hypersensitivity. In contrast, inhibition of TRPA1 with HC-030031 had no effect on mechanical sensitivity. These results suggest that the TRPV1 receptor contributes to primary afferent mechanical sensitization and a substantial portion of behavioral mechanical hypersensitivity in SCD mice. Therefore, TRPV1-targeted compounds that lack thermoregulatory side effects may provide relief from pain in patients with SCD.
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Abstract
Sickle-cell disease is one of the most common severe monogenic disorders in the world. Haemoglobin polymerisation, leading to erythrocyte rigidity and vaso-occlusion, is central to the pathophysiology of this disease, although the importance of chronic anaemia, haemolysis, and vasculopathy has been established. Clinical management is basic and few treatments have a robust evidence base. One of the main problems of sickle-cell disease in children is the development of cerebrovascular disease and cognitive impairment, and the role of blood transfusion and hydroxycarbamide for prevention of these complications is starting to be understood. Recurrent episodes of vaso-occlusion and inflammation result in progressive damage to most organs, including the brain, kidneys, lungs, bones, and cardiovascular system, which becomes apparent with increasing age. Most people with sickle-cell disease live in Africa, where little is known about this disease; however, we do know that the disorder follows a more severe clinical course in Africa than for the rest of the world and that infectious diseases have a role in causing this increased severity of sickle-cell disease. More work is needed to develop effective treatments that specifically target pathophysiological changes and clinical complications of sickle-cell disease.
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Affiliation(s)
- David C Rees
- Department of Paediatric Haematology, King's College Hospital NHS Foundation Trust, King's College London, London, UK.
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39
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Evaluation of meteorological factors on sudden cardiovascular death. J Forensic Leg Med 2010; 17:236-42. [DOI: 10.1016/j.jflm.2010.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/17/2009] [Accepted: 02/13/2010] [Indexed: 11/22/2022]
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Niscola P, Sorrentino F, Scaramucci L, de Fabritiis P, Cianciulli P. Pain syndromes in sickle cell disease: an update. PAIN MEDICINE 2009; 10:470-80. [PMID: 19416438 DOI: 10.1111/j.1526-4637.2009.00601.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Pain has a critical role in the management of sickle cell disease (SCD). Patients may suffer from several pain syndromes, which may be or not may be associated with other clinical complications, such as anemia, organ failures, and infections. DESIGN Data for review were identified by using PubMed to search MEDLINE, limiting the search to abstract/articles in English, Italian, French, and Dutch. The key words pain, sickle cell disease, anemia, hemoglobin, hemoglobinopathy, analgesics, opioids, morphine, acetaminophen, paracetamol, nonsteroidal anti-inflammatory drugs, hematology, and quality of life were variously combined in the title, abstract, and key word search list. The abstract database of most hematological congresses and the bibliographies of most relevant articles were also considered. RESULTS There are two major types of SCD pain: acute and chronic. Sometimes, mixed and neuropathic pain can be also observed. Acute pain is mostly related to vaso-occlusion. Chronic pain may be due to some SCD complications, such as leg ulcers and avascular necrosis. CONCLUSIONS Pain management in the SCD setting needs multidisciplinary approaches, given the several syndromes and the pathogenic mechanisms that are likely involved. Pain management is not standardized and often difficult, so that many patients with SCD are still poorly treated. Further efforts to develop care plans and treatment protocols as well as management guidelines are required.
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Acute pain in children and adults with sickle cell disease: management in the absence of evidence-based guidelines. Curr Opin Hematol 2009; 16:173-8. [DOI: 10.1097/moh.0b013e328329e167] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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43
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The effects of air quality on haematological and clinical parameters in children with sickle cell anaemia. Ann Hematol 2008; 88:529-33. [DOI: 10.1007/s00277-008-0598-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022]
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Nolan VG, Zhang Y, Lash T, Sebastiani P, Steinberg MH. Association between wind speed and the occurrence of sickle cell acute painful episodes: results of a case-crossover study. Br J Haematol 2008; 143:433-8. [PMID: 18729854 DOI: 10.1111/j.1365-2141.2008.07354.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of the weather as a trigger of sickle cell acute painful episodes has long been debated. To more accurately describe the role of the weather as a trigger of painful events, we conducted a case-crossover study of the association between local weather conditions and the occurrence of painful episodes. From the Cooperative Study of Sickle Cell Disease, we identified 813 patients with sickle cell anaemia who had 3570 acute painful episodes. We found an association between wind speed and the onset of pain, specifically wind speed during the 24-h period preceding the onset of pain. Analysing wind speed as a categorical trait, showed a 13% increase (95% confidence interval: 3%, 24%) in odds of pain, when comparing the high wind speed to lower wind speed (P = 0.007). In addition, the association between wind speed and painful episodes was found to be stronger among men, particularly those in the warmer climate regions of the United States. These results are in agreement with another study that found an association between wind speed and hospital visits for pain in the United Kingdom, and lends support to physiological and clinical studies that have suggested that skin cooling is associated with sickle vasoocclusion and perhaps pain.
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Affiliation(s)
- Vikki G Nolan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
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Yallop D, Duncan ER, Norris E, Fuller GW, Thomas N, Walters J, Dick MC, Height SE, Thein SL, Rees DC. The associations between air quality and the number of hospital admissions for acute pain and sickle-cell disease in an urban environment. Br J Haematol 2007; 136:844-8. [PMID: 17341271 DOI: 10.1111/j.1365-2141.2007.06493.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The clinical severity of sickle-cell disease (SCD) is dependent on genetic and environmental variables. Environmental factors have been poorly studied. We have investigated possible links between air pollution and acute pain in SCD. We retrospectively studied the numbers of daily admissions with acute sickle-cell pain to King's College Hospital, London, in relation to local daily air quality measurements. We analysed 1047 admissions over 1400 d (1st January 1998-31st October 2001). Time series analysis was performed using the cross-correlation function (CCF). CCF showed a significant association between increased numbers of admissions and low levels of nitric oxide (NO), low levels of carbon monoxide (CO) and high levels of ozone (O(3)). There was no association with sulphur dioxide (SO(2)), nitrogen dioxide or PM(10) (dust). The significant results were further examined using quartile analysis. This confirmed that high levels of O(3) and low levels of CO were associated with increased numbers of hospital admissions. Low NO levels were also associated with increased admissions but did not reach statistical significance on quartile analysis. Our study suggests air quality has a significant effect on acute pain in SCD and that patients should be counselled accordingly. The potential beneficial effect of CO and NO is intriguing and requires further investigation.
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Affiliation(s)
- Deborah Yallop
- Department of Haematology, King's College London School of Medicine at Guy's, UK
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