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Alsaad A, Alghanim A, Aldawood M, Al Zaid A, Aldehneen H, Aldrees R, Alsalem A, Albattat S, Al Mutair A. Psychological trauma and post-traumatic growth in parents of children with sickle cell disease. Heliyon 2024; 10:e34283. [PMID: 39114011 PMCID: PMC11305176 DOI: 10.1016/j.heliyon.2024.e34283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/10/2024] [Accepted: 07/07/2024] [Indexed: 08/10/2024] Open
Abstract
Sickle cell disease (SCD) is a hereditary blood condition characterized by abnormal hemoglobin, leading to chronic hemolysis and vaso-occlusive complications. Caregivers of children with SCD often experience significant distress, akin to post-traumatic stress disorder (PTSD). This study aimed to measure the degree of trauma and post-traumatic growth among parents (caregivers) of children with SCD in the Kingdom of Saudi Arabia. A total of 294 primary caregivers were recruited for this study, through direct phone calls and online outreach using contact information obtained from their primary treating physician in Maternity and Children Hospitals and the Hereditary Blood Diseases Center in Al-Ahsa. Inclusion criteria required caregivers not to be receiving professional mental health care and to have a child with SCD below the age of 18. Results indicate that caregiver gender significantly affected IESR scores, with mothers reporting higher scores than fathers. Family income had a significant effect on IESR as well. In terms of education level, higher-educated caregivers were less likely to experience severe trauma. Significant differences emerged between online and phone interview participants, with online respondents reporting higher post-traumatic growth and higher trauma levels. This study represents a crucial step in understanding the challenges faced by caregivers of children with SCD in Al-Ahsa, Saudi Arabia. However, the study has limitations, including a substantial portion of the sample being from a single clinic and a cross-sectional design.
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Affiliation(s)
- Ali Alsaad
- Department of Clinical Neurocience, King Faisal Universiry, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
- College of Medicine, King Faisal Universiry, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
| | - Abdullah Alghanim
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- College of Medicine, King Faisal Universiry, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
| | - Mohammed Aldawood
- Department of Neurology, King Fahad Specialist Hospital, Dammam, Eastern Province of Saudi Arabia, Saudi Arabia
- College of Medicine, King Faisal Universiry, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
| | - Ali Al Zaid
- Department of Urology, King Fahad Specialist Hospital, Dammam, Eastern Province of Saudi Arabia, Saudi Arabia
| | - Hussain Aldehneen
- College of Medicine, King Faisal Universiry, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
| | - Rawan Aldrees
- College of Medicine, King Faisal Universiry, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
- Department of Emergency medicine, King Fahad Hospital, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
| | - Ammar Alsalem
- College of Medicine, King Faisal Universiry, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
| | - Sami Albattat
- Department of Pediatric Hematology, Maternity and Children Hospital, Alahsa, Eastren Province of Saudi Arabia, Saudi Arabia
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Hasa, Saudi Arabia
- School of Nursing, University of Wollongong, Wollongong, Australia
- Department of Medical-Surgical Nursing, College of Nursing Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Nursing, Prince Sultan Military College of Health Sciences, Dahran, Saudi Arabia
- Almoosa College of Health Sciences, Al-Ahsa, Saudi Arabia
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Ibraheem RM, Abdulkadir MB, Aliu R, Issa A, Ibrahim OR, Bello AO, Abubakar FI, Oloyede IP, Olasinde YT, Briggs DC, Bashir MF, Salau QO, Garba BI, Ameen HA, Suleiman MB, Bewaji TO, Shina HK. Burden and outcome of respiratory morbidities among children and adolescents with sickle cell disease-A retrospective review of emergency presentations in some Nigerian tertiary institutions. PLoS One 2024; 19:e0303323. [PMID: 38753737 PMCID: PMC11098331 DOI: 10.1371/journal.pone.0303323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Despite the huge burden of sickle cell disease (SCD) among Nigerian children, the burden and outcome of respiratory illnesses remain undocumented. Thus, we aimed to describe the spectrum and outcome of respiratory illnesses among SCD childrenand adolescentadmissions in ten Nigerian tertiary hospitals. METHOD A retrospective review of the SCD admission records of children and adolescents with a confirmed diagnosis of respiratory illnesses from 2012 to 2021 in ten tertiary health facilities across five geopolitical zones in Nigeria was conducted. The data, collectedbetween March and June 2023, included the age, sex, diagnosis, complications, duration and outcome of hospitalization. RESULTS Of the 72,333 paediatric admissions, 7,256 (10.0%) had SCD; the proportion of SCD from the total admission ranged from 2.1 to 16.3% in the facilities. Of the 7,256 children and adolescents with SCD, 1,213 (16.7%) had respiratory morbidities. Lower respiratory disease was the most common (70.0%) respiratory entity and the majority were pneumonia (40.1.0%), followed by acute chest syndrome (26.7%). Seventeen (1.4%) patients died; all had lower respiratory diseases [(acute chest syndrome ACS (11, 64.7%), pneumonia; 5, 29.4%, and asthma (1, 5.9%). Based on the proportion of deaths among overall SCD, the 17 death cases contributed 9.4% (95% CI 5.9 to 14.5). Factors associated with deaths included duration of hospitalization less than 72 hours and lower respiratory tract diseases. CONCLUSION Sickle cell disease is a major contributor to hospitalization among Nigerian children and adolescents, with high respiratory morbidity and mortality. Pneumonia and acute chest syndrome were associated with mortality, andthe highest risk of death within the first 72 hours.
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Affiliation(s)
- Rasheedat Mobolaji Ibraheem
- Department of Paediatrics & Child Health, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Mohammed Baba Abdulkadir
- Department of Paediatrics & Child Health, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Rasaki Aliu
- Department of Paediatrics, Gombe State University & Federal Teaching Hospital Gombe, Gombe, Gombe State, Nigeria
| | - Amudalat Issa
- Department of Paediatrics, Children Specialist Hospital Centre-igboro, Ilorin, Kwara State, Nigeria
| | | | | | - Fatima Ishaq Abubakar
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Iso Precious Oloyede
- Department of Paediatrics, University of Uyo and University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Yetunde Toyin Olasinde
- Department of Paediatrics, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Datonye Christopher Briggs
- Department of Paediatrics, Rivers State University Teaching Hospital, Port Harcourt, Rivers state, Nigeria
| | | | | | - Bilkisu Ilah Garba
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Hafsat Abolore Ameen
- Department of Epidemiology & Community Health, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | | | | | - Hassan Kamiludeen Shina
- Department of Paediatrics, Gombe State University & Federal Teaching Hospital Gombe, Gombe, Gombe State, Nigeria
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Wasnik P, Das P, Kumar A, Kannauje PK, R R, Pandit V, Sahu T, Sahu J. Hospitalization Events Among Adolescents and Adults With Sickle Cell Disease in a Tertiary Care Center in Central India. Cureus 2024; 16:e61185. [PMID: 38933640 PMCID: PMC11200316 DOI: 10.7759/cureus.61185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited red blood cell disorder, wherein mutation causes the substitution of glutamic acid to valine at the sixth position of the β-globin chain. These include sickle cell anemia (homozygous sickle mutation), sickle-beta thalassemia, and hemoglobin SCD. The clinical manifestations of SCD are protean. Individuals with SCD suffer from both acute and chronic complications, which include recurring episodes of pain commonly called vaso-occlusive crisis (VOC) - acute chest syndrome (ACS); aseptic necrosis of the bone; micro-infarction of the spleen, brain, and kidney; infections; stroke; and organ damage affecting every part of the body. SCD necessitates frequent hospitalizations because of severe complications, which pose a significant burden on caregivers and economic strain on healthcare systems. The pattern of hospital admission with SCD varies in different parts of the world. OBJECTIVE This study aimed to determine the causes of hospitalization among adolescent and adult patients with SCD and to determine factors associated with their hospital stay. METHODS The study was a hospital-based prospective observational study comprising adolescent and adult patients diagnosed with SCD, aged 15-45 years, who were hospitalized in the Department of General Medicine at All India Institute of Medical Sciences in Raipur from August 2021 to August 2022. RESULT According to our study, the primary reason for hospitalization was a painful crisis, accounting for 63% of cases, followed by infection (17%), ACS (11%), and acute hemolytic crisis (9%). Notably, we did not observe any significant differences between genders and causes of admission (p > 0.05). Joint pain (p = 0.005), back pain (p = 0.001), and chest pain (p = 0.001) were more frequently reported by adults over the age of 19. In addition, our analysis of the duration of hospital stays and various factors revealed that patients admitted for infections had a significantly longer mean hospital stay duration (p = 0.040). CONCLUSION Acute painful crises were the primary cause of hospital admission among individuals with SCD; many patients also encountered infections and ACS. Furthermore, patients who experienced infections and VOC had a lengthier duration of hospital stay. Therefore, it is essential to provide them with comprehensive instructions on various preventive measures against infections and the factors that trigger painful crises.
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Affiliation(s)
- Preetam Wasnik
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Pranita Das
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Ajit Kumar
- General Medicine, Shri Balaji Institute of Medical Science, Raipur, IND
| | - Pankaj K Kannauje
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Rohini R
- Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Vinay Pandit
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Tarun Sahu
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Jyoti Sahu
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Oppong–Mensah YG, Odoom SF, Nyanor I, Amuzu EX, Yawnumah SA, Asafo‐Adjei E, Nguah SB, Ansong D, Osei‐Akoto A, Paintsil V. Hospitalizations among children with sickle cell disease enrolled in the Kumasi Sickle Cell Pan African Consortium (SPARCo) database: A cross sectional study. Health Sci Rep 2023; 6:e1534. [PMID: 37670846 PMCID: PMC10475768 DOI: 10.1002/hsr2.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/15/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Background and Aims Sickle cell disease (SCD) is the commonest monogenic haemolytic disorder in Africa. Despite strides made in its management, a significant proportion of patients are hospitalized from the various complications of the disease. This study set out to describe the main causes and outcomes of hospitalizations among pediatric patients with SCD. Methods A cross-sectional study was conducted at the Pediatric Emergency Unit of Komfo Anokye Teaching Hospital within a period of 12 months to recruit pediatric SCD patients. This study looked at causes of admission, length of hospital stay (LOS), and outcome of admission. Results Of the 201 SCD patients recruited, 57.2% were males and majority were of SCD-SS phenotype 83.1%. The median age was 6 years. The three leading causes of hospitalization were Vaso-occlusive pain events (VOPE) (39.8%), acute chest syndrome (ACS) (25.9%), and infections (12.4%). Ten (5.0%) of the patients presented with a stroke. High admissions were observed in June (12.4%) and November (16.9%). The median (interquartile range [IQR]) LOS was 6 days (IQR: 4-10). Six (3.0%) of the patients died from complications of the disease during hospitalization. Conclusion VOPE, ACS, infections, and acute anaemia from hyperhaemolysis were observed as the most common causes of admissions among SCD patients. A good outcome of discharge was seen in most of the patients that were hospitalized with a median length of stay of 6 days. This study also strengthens the importance of a good SCD database with patient follow-ups for better outcomes in SCD patients.
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Affiliation(s)
| | | | - Isaac Nyanor
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
| | | | | | | | - Samuel Blay Nguah
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Daniel Ansong
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Alex Osei‐Akoto
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Vivian Paintsil
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
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Singh A, Bokade C, Tirpude B, Suryawanshi MM, Rohadkar LA. Clinical Profiles of Children With Sickle Cell Anaemia Presenting With Acute Clinical Events: A Single-Center Study. Cureus 2023; 15:e39008. [PMID: 37378258 PMCID: PMC10292220 DOI: 10.7759/cureus.39008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Sickle cell disease is a common genetic disorder characterised by chronic haemolytic anaemia and vaso-occlusive crisis. Sickle cell anaemia (SCA) has both short-term effects in the form of acute clinical events and long-term repercussions seen with chronic multiorgan involvement. It is associated with significant morbidity and mortality. In India, the disease is largely undocumented. Thus, there is an urgent need to highlight the features of the disease so that locally appropriate models of care may be implemented. OBJECTIVE This study aims to evaluate acute clinical events in SCA and to provide data that may help to reduce the rate of morbidity and mortality associated with this disease by early interventions. MATERIALS AND METHODS A cross-sectional observational study was conducted between November 2020 and May 2022 at Indira Gandhi Government Medical College and Hospital, Nagpur, Central India. The inclusion criteria included previously diagnosed patients of SCA (homozygous sickle cell disease) on high-performance liquid chromatography (HPLC) between the age groups of six months and 12 years, presenting with acute clinical events. The exclusion criteria included patients younger than six months and older than 12 years of age, and all patients with other haemoglobinopathies and sickle cell trait. The study was approved by the Institutional Ethical Committee. All the data was entered into a well-designed Microsoft Office Excel spreadsheet (v 2019, Microsoft, Washington, USA). All the clinical, biochemical, and haematological data were tabulated and analysed. RESULTS A total of 100 children with sickle cell disease diagnosed by HPLC were enrolled during the study period. About 215 acute clinical events among the 100 cases were recorded, for which they were admitted to the paediatric ward or PICU. The majority (35%, n=35) were seen in the age group of six to nine years (school-going age). About 52% were male and 48% were female (male-to-female ratio= 1.08:1). Pain was the most common symptom. The highest incidence of 36.75% (n=79) was seen with acute painful crises and was the most common indication of hospitalisation, followed by acute febrile illness (AFI) (34.42%, n=74), aplastic crisis (10.23%, n=22), splenic sequestration crisis (9.77%, n=21), hepatobiliary involvement (3.72%, n=8), acute chest syndrome and haemolytic crisis (each 1.86%, n=4), and stroke (1.40%, n=3). In cases of having foetal haemoglobin (HbF) ≥20%, the incidence of acute painful crisis (p=0.0001), hand-foot syndrome (p=0.047), aplastic crisis (p=0.033), splenic sequestration crisis (p=0.039), and AFI (p=0.035) was low as compared to cases having HbF ≤20% which was statistically significant. The incidence of acute painful crisis, hand-foot syndrome, and an aplastic crisis was significantly low in patients receiving hydroxyurea therapy as compared to patients who were not on hydroxyurea. Out of 100 cases, four died during the study period, three died because of splenic sequestration crisis with septic shock, and one died due to hepatic encephalopathy due to haemolytic crisis with septic shock. CONCLUSION Acute clinical events in sickle cell disease can have significant morbidity and mortality in the paediatric age group. The nutritional status of sickle cell disease children must be given due importance. Early initiation of hydroxyurea must be encouraged to maintain higher HbF levels, which plays a significant role in reducing morbidity.
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Affiliation(s)
- Anwesha Singh
- Pediatrics and Neonatology, Indira Gandhi Government Medical College and Hospital, Nagpur, IND
| | - Chandrakant Bokade
- Pediatrics and Neonatology, Indira Gandhi Government Medical College and Hospital, Nagpur, IND
| | - Bhagyashree Tirpude
- Pediatrics and Neonatology, Indira Gandhi Government Medical College and Hospital, Nagpur, IND
| | - Milind M Suryawanshi
- Pediatrics and Neonatology, Indira Gandhi Government Medical College and Hospital, Nagpur, IND
| | - Lakshmikant A Rohadkar
- Pediatrics and Neonatology, Indira Gandhi Government Medical College and Hospital, Nagpur, IND
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Suliman OSM, Elamin HAM. Zinc level and effect of zinc supplementation on growth in a subset of Sudanese children with sickle cell disease. Sudan J Paediatr 2023; 23:214-223. [PMID: 38380417 PMCID: PMC10876280 DOI: 10.24911/sjp.106-1638821311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/18/2023] [Indexed: 02/22/2024]
Abstract
A case-control interventional study was conducted to determine serum zinc levels in children with sickle cell disease (SCD) and to compare them to the levels in normal children and to the levels after 6 months of zinc supplementation. A total of 74 patients and 30 normal children, considered as controls for the zinc levels, were included. The clinical findings, including anthropometric measurements, were obtained. Serum zinc levels at the start and after 6 months, for the patients and at the start for the controls were measured. The mean age at enrolment and diagnosis were 7.5 ± 4.8 years and 5.5 ± 2.4 months, respectively. Male to female ratio was 1:1. Patients showed very low zinc levels at enrolment (0.268 ± 0.146 mg/l), while the controls had a mean zinc level at lower limits of normal (0.542 ± 0.087 mg/l) and a p-value of 0.04. After zinc supplementation, zinc levels in patients increased significantly with a p-value = 0.04. Zinc supplementation had positive effects on weight and height, with a p-value of 0.001 for both. The increase in body mass index and HC were not significant, with p-values of 0.058 and 0.067, respectively. Likewise, zinc supplementation had positive effects on the haematological indices as an increase in haemoglobin levels and a decrease of leucocyte counts, with p = 0.004 and 0.005, while the increase in platelet count was insignificant, p-value = 0.058. Furthermore, zinc supplementation decreased the frequency of hospitalisation significantly. We recommend considering zinc supplementation as one of the standard-of-care interventions in Sudanese children with SCD.
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Affiliation(s)
- Omer S. M. Suliman
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Hiba A. M. Elamin
- Paediatrics Specialist, Summerland Medical Centre, Shakhbout City, AbuDhabi, UAE
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Abd El-Ghany SM, Tabbakh AT, Nur KI, Abdelrahman RY, Etarji SM, Almuzaini BY. Analysis of Causes of Hospitalization Among Children with Sickle Cell Disease in a Group of Private Hospitals in Jeddah, Saudi Arabia. J Blood Med 2021; 12:733-740. [PMID: 34408522 PMCID: PMC8364845 DOI: 10.2147/jbm.s318824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Sickle cell anemia (SCA) is a chronic hematologic condition that requires frequent hospitalization representing a significant economic burden on the health services. The aim of this study was to explore the causes and underlying factors of hospitalization among children with SCA, as well as the factors affecting their length of hospital stay. Patients and Methods This retrospective study included children and adolescents less than 16 years old who were admitted in a group of private hospitals in Jeddah, Saudi Arabia, during the period from January 2018 to December 2019. Results A total of 94 patients were included in this study, 59.6% were males, with a mean age 7.29 ± 3.82 years. The majority of the patients (91.5%) had sickle cell disease. The most common cause of hospital admission was vaso-occlusive crises (VOC) (64.9%) followed by infection (24.5%), acute chest syndrome (ACS) (18.1%), and acute hemolytic crisis (12.8%). We found no significant difference between gender and different causes of admissions (p > 0.05). While in relation to age group, limb pain and back pain were found to be significantly more frequent among children ≥ 7 years old (p = 0.03,0.04), while infections were significantly more frequent among children < 7 years old (p = 0.003). We analyzed the length of hospital stay and different factors, and we found that the mean length of hospital stay was significantly higher among children who were admitted with infections (p = 0.01) and ACS (p < 0.001) and among children who are non-compliant on hydroxyurea (p = 0.04). Conclusion The most common cause of hospitalization among children with SCD in Jeddah, Saudi Arabia, was VOC followed by infection, ACS and acute anemia. The length of hospital stay was more prolonged among children with infection and ACS, as well as children who were non-compliant to hydroxyurea.
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Affiliation(s)
- Shereen M Abd El-Ghany
- Department of Pediatrics, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia.,Department of Pediatrics, Hematology and Oncology Unit, Ain Shams University, Cairo, Egypt
| | - Aisha T Tabbakh
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Khulud I Nur
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Rayan Y Abdelrahman
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Sara M Etarji
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Bayan Y Almuzaini
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
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Blood Transfusion Frequency and Indications in Yemeni Children with Sickle Cell Disease. Anemia 2020; 2020:7080264. [PMID: 32908695 PMCID: PMC7469078 DOI: 10.1155/2020/7080264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/18/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background Blood transfusion is an essential component in the care of patients with sickle cell disease (SCD), but it might be associated with serious acute and delayed complications. This study was aimed to describe red cell transfusion patterns and indications among hospitalized SCD children in a low-resource setting. Patients and Methods. A retrospective, descriptive study of all children (≤16 years) with SCD who received blood transfusion therapy during their hospital admissions in the pediatric department at Al-Sadaqa Teaching Hospital in Aden, Yemen, for a period of one year. Results Out of 217 hospitalized children with SCD, 169 (77.9%) were transfused and received 275 RBC transfusion episodes. The mean age of transfused children was 6.9 ± 4.6 years and 103 (60.9%) were males, with a male/female ratio of 1.6 : 1 (p=0.004). Hemoglobin (Hb) levels were significantly lower in the transfused than in the nontransfused (Hb 5.5 ± 1.5 vs. 7.7 ± 1.5 g/dL, p=0.03). Pretransfusion Hb levels were ˂7.0 g/dL in 86.2% and ˂5.0 g/dL in 39.3% of patients. Single transfusion was given to 122 (72.2%) and 5 or more transfusions in 9 (4.15%) of patients on different occasions. Simple (top-up) transfusion was used in all transfusion events. Commonest indications for transfusion were anemic crises (41.1%), vasoocclusive crises (VOC) (13.8%), VOC with anemic event (11.3%), acute chest syndrome (8.7%), and stroke (7.3%). Conclusion Intermittent blood transfusion remains a common practice for the management of children with acute SCD complications. Main indications were acute anemic crises, severe pain crises, ACS, and stroke. In limited resource settings, such as Yemen, conservative transfusion policy appears to be appropriate.
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Kazadi AL, Ngiyulu RM, Gini-Ehungu JL, Mbuyi-Muamba JM, Aloni MN. The clinical characteristics of Congolese children and adolescents suffering from sickle-cell anemia are marked by the high frequencies of epistaxis compared to Western series. Pediatr Hematol Oncol 2019; 36:267-276. [PMID: 31339399 DOI: 10.1080/08880018.2017.1365397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Sickle cell anaemia (SCA) is the most common genetic diseases in the Democratic Republic of Congo (DRC). It is estimated 30,000 to 40,000 neonates with SCA are born annually. Despite this high incidence rate, and the severity of the Bantu haplotype found in Congolese patients, major clinical characteristics remain poorly defined. The objective of this study was to assess the clinical and haematological profile of the SCA in patients less than 24 years of age. Methods: A cross-sectional study was conducted in Kinshasa, the large city of the DRC. Patients were consecutively selected in three health institutions. Results: The study includes 256 sickle cell patients. The mean age of 8.4 (SD = 4.9) years. The Hand-foot syndrome was most common (52.7%) first presentation revealing the disease in our series. The most prevalent crises found in our series were vaso-occlusive crises (VOC) in 170 cases (66.4%) and severe hemolysis in 136 cases (53.1%). Splenic sequestration was noted in 19 cases (7.4%). The age at the first pain crisis was 18.2±15.2 months-of-age and the age at the first transfusions was 29.2±27.6 months-of -age. The most common signs associated with sickle cell disease in our series were hepatomegaly (53.9%), splenomegaly (41.7%), and adenotonsillar hypertrophy (34.8%). Epistaxis was reported in 9.4%. Conclusion: The clinical course of patients in DRC was comparable to reports from Western countries, with the notable exception of epistaxis which was significantly higher in patients in the DRC.
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Affiliation(s)
- Aimé L Kazadi
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa,Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
| | - René M Ngiyulu
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa,Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
| | - Jean L Gini-Ehungu
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa,Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
| | - Jean M Mbuyi-Muamba
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
| | - Michel N Aloni
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa,Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
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Jose J, Elsadek RA, Jimmy B, George P. Hydroxyurea: Pattern of Use, Patient Adherence, and Safety Profile in Patients with Sickle Cell Disease in Oman. Oman Med J 2019; 34:327-335. [PMID: 31360322 PMCID: PMC6642718 DOI: 10.5001/omj.2019.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Many barriers contribute to the underutilization of hydroxyurea (HU) in the treatment of sickle cell disease (SCD), and adherence to its use is often reported to be suboptimal. It is important to have information on the safety of HU in patients with SCD. Our study assessed the pattern of use, patients' adherence to medication, discontinuation of use, and safety of HU in patients with SCD. METHODS This cross-sectional study was conducted in the department of medicine of a referral hospital in Oman over five months and included a review of patient files and patient interview. Approval was obtained from the Regional Research and Ethics Committee of the A'Dakhiliyah Governorate and the hospital administration. The parameters were compared between groups using the chi-square test. RESULTS Of 298 patients studied, 128 (43.0%) had used HU at some points. The difference in the prevalence of HU use was statistically significant based only on age (p = 0.014), with younger patients more likely to be currently using HU or used HU in the past. The majority of patients were adherent (82.5%) based on self-reported adherence. The prevalence of discontinuation (temporary or permanent) of HU use was high (57.0%), and suspected adverse drug reaction (ADR) was the most common reason. Among those who had never used HU, 33.7% of patients had an indication for the initiation of HU. A quarter of patients who used HU developed a suspected ADR, with blood abnormalities being the commonest. The duration of HU use influenced ADR prevalence (p = 0.015). CONCLUSIONS Among the current users of HU, the majority of the patients were adherent based on self-reported medication adherence. The prevalence of discontinuation of HU use and instances of non-initiation of HU among those indicated were high. A larger study, ideally of a prospective nature, in various governorates of Oman, would provide a wider picture at the national level.
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Affiliation(s)
- Jimmy Jose
- School of Pharmacy, University of Nizwa, Nizwa, Oman
| | | | - Beena Jimmy
- School of Pharmacy, University of Nizwa, Nizwa, Oman
| | - Prasad George
- Department of General Medicine, Nizwa Hospital, Nizwa, Oman
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Chambers TM, Kahan S, Camanda JF, Scheurer M, Airewele GE. Intermittent or uneven daily administration of low-dose hydroxyurea is effective in treating children with sickle cell anemia in Angola. Pediatr Blood Cancer 2018; 65:e27365. [PMID: 30051651 DOI: 10.1002/pbc.27365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/30/2018] [Accepted: 06/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although hydroxyurea is proven effective in treatment of sickle cell anemia (SCA) and is widely prescribed in high-income countries, due to questions about feasibility of treating large numbers of patients in resource-limited health systems, its use is limited in sub-Saharan Africa (SSA), where most children with SCA live. We assessed hematological response and toxicity of hydroxyurea treatment for SCA in Angola. METHODS Retrospective study of children with SCA (not selected for clinical severity) treated on a fixed dose of hydroxyurea for at least 6 months. Because only the 500 mg capsule was available, dose was averaged weekly. We evaluated toxicity events and magnitude of hydroxyurea-induced changes in blood counts and compared patients who received a uniform daily dose to those prescribed intermittent or uneven daily doses. RESULTS Only 13% of 303 patients received a uniform dose of hydroxyurea daily. Dose ranged from 16.5 to 22.8 mg/kg/day. Hydroxyurea increased HGB and mean cell volume values by 0.5 g/dL (P < 0.0001) and 8 fL (P < 0.0001), while ANC, PLT, and ARC decreased 1.1 × 109 /L (P < 0.0001), 34 × 109 /L (P = < 0.0001), and 19 × 109 /L (P = 0.0008), respectively. There were no differences in magnitude of hydroxyurea-induced changes between patients prescribed intermittent or uneven doses and uniform daily doses, or between those treated in the lower and higher dose quartiles. Hematological toxicity events were mild and reversible. CONCLUSION Intermittent or uneven daily dosing of hydroxyurea is as effective as fixed daily doses in treating SCA. This strategy may enable treatment of additional children with SCA in SSA.
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Affiliation(s)
- Tiffany M Chambers
- Department of Pediatrics-Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Silvina Kahan
- Global Health Corps, Baylor College of Medicine, Houston, Texas
| | - Joao F Camanda
- Faculty of Medicine, Universidade 11 de Novembro, Cabinda, Angola
| | - Michael Scheurer
- Department of Pediatrics-Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Gladstone E Airewele
- Department of Pediatrics-Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
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