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Adeniyi O, Salako A, Sokunbi O, Odubela O, Aworanti O, Okoromah C, Akinsulie A. Prevalence and associated risk factors of myocardial ischemia in children living with sickle cell anemia in Lagos, Nigeria. J Trop Pediatr 2024; 70:fmae035. [PMID: 39413805 DOI: 10.1093/tropej/fmae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2024]
Abstract
Myocardial ischemia (MI) in children living with sickle cell anemia (SCA) is rarely reported. MI among children living with this disease could portend untoward outcomes on their quality of life and survival. This study evaluated the prevalence and associated risk factors of MI in children living with SCA during a vaso-occlusive crisis (VOC) compared with those with SCA who had no symptoms nor an MI in the past (those in "steady state") in Lagos, Nigeria. This comparative cross-sectional study was conducted over 10 months (between March and December 2019) among 250 children living with SCA aged 6 months-18 years (125 in VOC and 125 age and sex-matched controls in steady state). The assessment of MI was determined by measuring cardiac troponin T (cTnT) and electrocardiography (ECG). The prevalence of MI measuring cTnT alone in children with SCA during VOC and steady state was 42.4% and 23.2%, respectively. Comparatively, measuring ECG alone, the prevalence of MI in VOC and steady state was 40.8% and 20.8%, respectively. The prevalence of MI measuring cTnT and ECG in children with SCA in VOC and steady state was 38.4% and 20%, respectively. Older age, severity of pain, longer duration of illness, frequent crises per year, elevated white blood cells, and platelet count were significantly associated with MI in participants with SCA. However, with multivariate analysis, age, severity of pain, and elevated platelet counts remained significantly associated with the occurrence of MI. This study affirms the high prevalence of MI in children with SCA irrespective of the diagnostic criteria. Routine evaluation should be done in this cohort to avert MI-associated sequelae.
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Affiliation(s)
- Oluwatoyin Adeniyi
- Department of Paediatrics, Orile Agege General Hospital, Lagos, 102212, Nigeria
| | - Abideen Salako
- Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba, Lagos, 101245, Nigeria
- Graduate School of Biomedical Sciences, Global Paediatric Medicine, St Jude Research Hospital, Memphis, TN, 38105-3678, United States
| | - Ogochukwu Sokunbi
- Department of Paediatrics, Lagos University Teaching Hospital, Idiaraba, Lagos, 100254, Nigeria
| | - Oluwatosin Odubela
- Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba, Lagos, 101245, Nigeria
| | - Oladapo Aworanti
- Department of Haematology, University College Hospital, Ibadan, Oyo, 200212, Nigeria
| | - Christy Okoromah
- Department of Paediatrics, Lagos University Teaching Hospital, Idiaraba, Lagos, 100254, Nigeria
| | - Adebola Akinsulie
- Department of Paediatrics, Lagos University Teaching Hospital, Idiaraba, Lagos, 100254, Nigeria
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Obeagu EI, Adias TC, Obeagu GU. Advancing life: innovative approaches to enhance survival in sickle cell anemia patients. Ann Med Surg (Lond) 2024; 86:6021-6036. [PMID: 39359845 PMCID: PMC11444627 DOI: 10.1097/ms9.0000000000002534] [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: 06/02/2024] [Accepted: 08/26/2024] [Indexed: 10/04/2024] Open
Abstract
Sickle cell anemia (SCA) is a severe genetic disorder characterized by the production of abnormal hemoglobin S, leading to the formation of sickle-shaped red blood cells that cause chronic anemia, pain, and organ damage. This review explores recent innovative strategies aimed at improving survival rates and quality of life for SCA patients. Genetic therapies, particularly gene editing with CRISPR-Cas9 and gene therapy using lentiviral vectors, have shown significant potential in correcting the genetic defects responsible for SCA. Clinical trials demonstrate that these approaches can reduce sickle cell crises and minimize the need for blood transfusions by enabling the production of healthy red blood cells. Novel pharmacological treatments such as voxelotor, crizanlizumab, and L-glutamine provide additional mechanisms to prevent hemoglobin polymerization, reduce vaso-occlusive episodes, and decrease oxidative stress, respectively. These therapies offer new hope for patients, particularly those who do not respond adequately to existing treatments. Improved blood transfusion protocols, including automated red cell exchange and advanced donor-matching techniques, have enhanced the safety and efficacy of transfusions, reducing complications like alloimmunization. Comprehensive care models, integrating multidisciplinary care teams, patient education, and telemedicine, have further contributed to better disease management. By providing holistic care that addresses both medical and psychosocial needs, these models improve patient adherence to treatment and overall health outcomes. This review highlights the importance of these innovative strategies and calls for continued research and development to sustain and expand these advancements in SCA care.
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Affiliation(s)
| | - Teddy Charles Adias
- Department of Haematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Federal University Otuoke, Bayelsa State, Nigeria
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Kwagala C, Munube D, Abbo C, Muhwezi WW, Mwesiga EK. Prevalence and factors associated with opioid use disorder among adolescents with sickle cell disease in Mulago hospital, Uganda. Child Adolesc Psychiatry Ment Health 2024; 18:94. [PMID: 39090740 PMCID: PMC11295896 DOI: 10.1186/s13034-024-00790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Opioid use disorder (OUD) among adolescents with sickle cell disease (SCD) patients increases their risk of complications from sickle cell disease, such as infections, stroke, acute chest syndrome, sudden death, and organ failure. This negatively impacts families, communities, the national health system, and the economy. This study aimed to determine the prevalence and factors associated with opioid use disorder among adolescents with SCD at Mulago Hospital Uganda. METHODS This study was carried out at the Sickle Cell Clinic of Mulago Hospital, the national referral hospital in Uganda. The study participants were adolescents aged 10 to 19 years. Following informed consent/ assent, a sociodemographic questionnaire, the WHO Alcohol, Smoking and Substance Involvement Screening Test - Young (ASSIST-Y), the Beck Depression Inventory-II (BDI II), and Generalized Anxiety Disorder - 7 (GAD-7) questionnaires were used to collect data. Data was entered in EpiInfo and analyzed in STATA 15. RESULTS The prevalence of opioid use disorder was 5.3%. The significant risk factor was increasing depressive score AOR: 1.11(95% CI: 1.01-1.22, p = 0.035), while living with a family was protective against opioid use disorders AOR: 0.01; (95% CI: 0.0004, 0.27, p = 0.007). CONCLUSION There was a significant problem of OUD among adolescents with SCD. There is, therefore, needed to integrate screening of OUD and mental illnesses like depression among adolescents with SCD and to emphasize the importance of family support in their care.
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Affiliation(s)
- Claire Kwagala
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
| | - Deogratias Munube
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Wilson Winstons Muhwezi
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Emmanuel Kiiza Mwesiga
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
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Charles KS, Friday M, Rochford E. Acute painful crisis in adults with sickle cell disease. BMJ 2024; 386:e075099. [PMID: 38950962 DOI: 10.1136/bmj-2023-075099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Affiliation(s)
- Kenneth S Charles
- Faculty of Medical Sciences, The University of the West Indies, Trinidad and Tobago
| | - Melissa Friday
- Haematology Department, Royal Hallamshire Hospital, Sheffield, UK
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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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Arrey Agbor DB, Panday P, Ejaz S, Gurugubelli S, Prathi SK, Palou Martinez Y, Nassar ST. Folic Acid in the Treatment of Sickle Cell Disease: A Systematic Review. Cureus 2024; 16:e57962. [PMID: 38738102 PMCID: PMC11085970 DOI: 10.7759/cureus.57962] [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] [Received: 03/18/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Sickle cell disease (SCD) is a group of inherited genetic disorders that is caused by a mutation in the gene that codes for hemoglobin subunit β. This systematic review aimed to evaluate the effect of folic acid in the treatment of SCD patients. We retrieved 3730 articles from PubMed, PubMed Central, Google Scholar, and ScienceDirect databases. We employed a search technique that involved framing keywords, such as folic acid, folate, and sickle cell illness, and the Medical Subject Headings (MeSH) strategy in PubMed. We chose research articles that had been published during the last 10 years, as well as case reports, systematic reviews and meta-analyses, literature reviews, randomized controlled trials, and observational studies. Exclusion criteria included paid full-text articles, abstracts, non-English studies, and patients who do not have SCD. The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used in the design of our systematic review. It was found that the majority of SCD patients were receiving regular folic acid supplements and that their plasma folate levels were either increased or within normal range, with no discernible impact on other clinical outcomes such as hemoglobin levels, infections, or pain crises. SCD patients produce more red blood cells than healthy individuals, and nearly all SCD patients receive daily folic acid supplements. On the other hand, not enough information is available on folic acid's potential benefits in the management of SCD; thus, there is a need for more large clinical trials.
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Affiliation(s)
- Divine Besong Arrey Agbor
- Clinical Research and Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Priyanka Panday
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Samrah Ejaz
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Suviksh K Prathi
- Medical School, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medical School, St. George's University School of Medicine, St. George's, GRD
| | | | - Sondos T Nassar
- Medicine and Surgery, Jordan University of Science and Technology, Irbid, JOR
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Oloyede IP, Ahunanya CN, Uduma FU, Eduwem DU. Clinical Profile and middle cerebral artery velocity of children with sickle cell anaemia seen in UUTH, Uyo, Akwa Ibom state, Nigeria. Niger Med J 2024; 65:195-205. [PMID: 39005556 PMCID: PMC11240204 DOI: 10.60787/nmj-v65i2-430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Background The risk of stroke in individuals with Sickle Cell Anaemia (SCA) can be assessed by routine non-invasive measurement of their cerebral blood flow using a Transcranial Doppler (TCD) ultrasound scan. This study aimed to determine the difference in blood flow velocity parameters in the middle cerebral artery (MCA) of children with sickle cell anaemia compared to a normal age-matched population. Methodology This was a hospital-based comparative cross-sectional study among 40 SCA patients aged 3-16 years, in steady state and 40 age and sex-matched HbAA healthy subjects. This study lasted from June to October 2019. Medical history was retrieved using a structured questionnaire. The time-averaged mean of maximum velocity (TAMMV) of the right and left MCA was measured using non-imaging TCD. Results The mean age ± SD of the SCA patients was 9.1 ± 4.4 years. The SCA patients and sex and age-matched HbAA group consisted of 23 (57.5%) males and 17 (42.5%) females respectively. SCA patients had a significantly lower mean ± SD haemoglobin (Hb) than the controls (7.1 ± 1.1g/dl vs 11.1 ± 1.4g/dl; p<0.001). The right MCA of the patients with SCA had a significantly higher mean flow velocity compared to the controls (94.1 ± 23.1 vs 55.0 ± 8.8cm/sec, p<0.001). Conclusion The mean TAMMV recorded in the SCA subjects were significantly higher than that of the non-SCA subjects. There is a need to ensure that TCD ultrasound is employed as a routine screening tool for stroke risk among SCA patients in Nigerian tertiary health institutions.
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Affiliation(s)
- Iso Precious Oloyede
- Department of Paediatrics, University of Uyo/ University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Chukwudi N Ahunanya
- Nigeria Police Medical Services, Police Hospital, Port Harcourt, Rivers State, Nigeria
| | - Felix U Uduma
- Department of Radiology. University of Uyo/ University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Dianabasi U Eduwem
- Department of Radiology. University of Uyo/ University of Uyo Teaching Hospital, Uyo, Nigeria
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Batra N, Acharya S, Ahuja A, Saboo K. Guarding Health: A Comprehensive Review of Nosocomial Infections in Sickle Cell Anemia, a Multifaceted Approach to Prevention. Cureus 2024; 16:e53224. [PMID: 38425631 PMCID: PMC10902742 DOI: 10.7759/cureus.53224] [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: 12/06/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
This comprehensive review explores the complex dynamics of nosocomial infections in individuals with sickle cell anemia (SCA) and advocates for a collaborative strategy to enhance prevention. SCA patients, marked by compromised immunity and susceptibility to infections, face unique challenges that necessitate tailored preventive measures. The review underscores the importance of vaccination, antibiotic prophylaxis, education, and environmental hygiene in mitigating the risk of nosocomial infections. Addressing socioeconomic factors, healthcare system limitations, patient-related issues, and cultural considerations is imperative for effective prevention. The call to action emphasizes the pivotal roles of healthcare professionals, policymakers, researchers, and community engagement in implementing targeted interventions. By fostering a collective effort, this review envisions an improved landscape for infection prevention in SCA patients, enhancing their overall health outcomes and quality of life.
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Affiliation(s)
- Nitish Batra
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Abhinav Ahuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Keyur Saboo
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Nwosu CS, Nri-Ezedi CA, Okechukwu C, Ulasi TO, Umeh EO, Ebubedike UR, Aronu ME, Obi-Nwosu AL, Odita AO, Agu NV, Ngonadi SC, Emedike NC, Uke KM, Emegoakor AC. Two-Dimensional Ultrasound Assessment of Long-Term Intra-Abdominal Organ Changes in Children with Sickle Cell Anemia during Steady State: A Comparative Study. Niger J Clin Pract 2023; 26:1861-1867. [PMID: 38158354 DOI: 10.4103/njcp.njcp_411_23] [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: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Sickle cell anemia (SCA) is a hereditary blood disorder with global prevalence, including in Nigeria. Despite advancements in SCA care management, understanding the long-term impact on organs during steady state has remained inconclusive. AIM This study aimed to investigate the long-term changes in intra-abdominal organs of SCA children compared with non-SCA children during steady state using two-dimensional ultrasound assessment. MATERIALS AND METHODS A total of 116 children (58 SCA and 58 controls) were enrolled between June 2021 and July 2022. Clinico-demographic data were collected through an interviewer-administered questionnaire. Two-dimensional ultrasound was used to measure the liver, spleen, kidneys, and inferior vena cava in all subjects. Age-matched controls had AA or AS genotypes. RESULTS Of the 58 patients with SCA, 65.5% were males with an overall mean age of 8.1 ± 3.4 years, while among the non-SCA cohort (n = 58), 48.3% were males with an overall mean age of 8.7 ± 3.9 years. There was no statistically significant difference in the age and gender distribution between the SCA and non-SCA cohorts (P = 0.390 and P = 0.091, respectively). SCA subjects had a larger mean hepatic size than non-SCA subjects (12.09 cm ± 2.23 vs. 11.67 cm ± 1.96; P = 0.276) but smaller mean splenic size (8.01 cm ± 1.89 vs. 8.19 cm ± 1.61; P = 0.577) and inferior vena cava diameter (1.16 cm ± 0.29 vs. 1.25 cm ± 0.33; P = 0.100). Left kidney length and breadth were significantly greater in SCA patients (8.91 ± 1.16 vs. 8.27 ± 1.30; P = 0.006 and 4.15 ± 0.92 vs. 3.79 ± 0.48; P = 0.008, respectively). CONCLUSION This study highlights the utility of two-dimensional ultrasound assessment in monitoring intra-abdominal organ changes in SCA children, suggesting its cost-effective benefits in monitoring health outcomes in SCA patients.
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Affiliation(s)
- C S Nwosu
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - C A Nri-Ezedi
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - C Okechukwu
- Department of Paediatrics and Child Health, Rivers State University Teaching Hospital, Port-Harcourt, Rivers State, Nigeria
| | - T O Ulasi
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - E O Umeh
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - U R Ebubedike
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - M E Aronu
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - A L Obi-Nwosu
- Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - A O Odita
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - N V Agu
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - S C Ngonadi
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - N C Emedike
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - K M Uke
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - A C Emegoakor
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Ajibade A, Michael O. PRELIMINARY REPORT ON THE USE OF NUTRACEUTICALS IN THE MANAGEMENT OF SICKLE CELL ANEMIA: A CASE SERIES. Ann Ib Postgrad Med 2023; 21:89-95. [PMID: 38706619 PMCID: PMC11065187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/30/2023] [Indexed: 05/07/2024] Open
Abstract
Background There is growing recognition of the benefits of nutraceuticals in the management of sickle cell disease but a scarcity of reports on their use. Nutraceuticals are food or parts of food that provide medical or health benefits. They include botanicals, functional foods and medicinal foods. This is a preliminary report on the use of nutraceuticals in the management of a small cohort of children with sickle cell disease in Nigeria. Patients and Methods The retrospective audit of clinical outcomes was carried out at a brain center located within the Federal Capital Territory, Abuja, Nigeria. Children, aged 1 to 12 years, presenting with sickle cell anaemia were evaluated at baseline and at six months after the commencement of a cocktail of nutraceuticals using an objective grading tool. Changes in weight, haematocrit and frequency of sickle cell crises were determined. On account of the small sample size, Wilcoxon sign test was used to determine the similarity / difference between the average values of weight, PCV, and crises obtained at enro7lment and six months. Results Ten children with sickle cell anaemia were placed on nutraceuticals therapy. The average age of the children was 8.5 (range 1 - 12) years. Aroga immune support was the commonest component of the nutraceutical cocktail given to the children. There was a rise in average weight (from 21.8 to 23.0 Kg, p-value 0.236) and average haematocrit (22.8 to 27.2, p-value 0.011) at six months compared to values obtained at baseline. There was also a fall in the average frequency of sickle cell crises at six months compared to values obtained at baseline (from 7.4 to 3.2, p-value 0.011). Overall, eight out of the ten children showed moderate to good clinical improvement. There was no documentation of any adverse reaction to the medications in any of the children. Conclusion The results suggest that the use of nutraceuticals may be beneficial in the management of sickle cell anaemia in children. However, the results are preliminary and will require stronger evidence. There is a need for controlled clinical trials for using larger sample sizes. Such clinical trials of unconventional therapies should be conducted with great care and concern for the safety of the participants.
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Affiliation(s)
| | - O.S. Michael
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Nigeria
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Essien EA, Winter-Eteng BF, Onukogu CU, Nkangha DD, Daniel FM. Psychosocial challenges of persons with sickle cell anemia: A narrative review. Medicine (Baltimore) 2023; 102:e36147. [PMID: 38013366 PMCID: PMC10681612 DOI: 10.1097/md.0000000000036147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023] Open
Abstract
Sickle cell anemia (SCA) is a severe form of sickle cell disease that primarily affects black populations and individuals in tropical countries. This condition causes significant morbidity and mortality and leads to a range of psychosocial challenges. A preliminary search was conducted on Ovid Medline and public databases with a combination of Medical Subject Headings keywords, resulting in 368 articles. The articles were screened based on the selection criteria in a nonsystematic method by 3 researchers, and a narrative synthesis was done to analyze extracted data from selected peer-reviewed article. Mental disorders, sleep disturbances, interpersonal relationship challenges, stigmatization, and workplace discrimination were identified as significant contributors to the psychosocial distress experienced by individuals with SCA and their families. Depression and anxiety were prevalent among individuals with SCA, leading to poor treatment adherence, increased pain, and disruptions in various aspects of life. Sleep disturbances, including sleep-disordered breathing and sleepwalking, were also identified as significant contributors to poor sleep quality in SCA patients. Families of individuals with SCA also face challenges, including psychological stress, financial strain, and social disruption. Stigmatization is common, leading to misconceptions and discrimination. Workplace discrimination is prevalent, with a high unemployment rate among adult SCA patients. Comprehensive care is crucial to address these psychosocial issues. Early identification and intervention, comprehensive support programs, patient and family education, enhanced pain management strategies, and integration of mental health into clinical care are recommended. School-based support, research and advocacy, and community support groups are also important. By addressing these challenges through comprehensive care and support, healthcare professionals, policymakers, and society can reduce psychosocial distress and improve the lives of individuals with SCA.
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Alshehri A, Alfadhel A, AlZahrani A, Alqahtani Y, Al Qahtani A. Elective Laparoscopic Cholecystectomy Complicated by Hemorrhagic Crisis in a Patient With Sickle Cell Disease. Cureus 2023; 15:e49502. [PMID: 38161830 PMCID: PMC10756027 DOI: 10.7759/cureus.49502] [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: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Sickle cell disease (SCD) is a common genetic disorder associated with complications such as cholelithiasis. Cholecystectomy is often performed in SCD patients, but they have a higher risk of postoperative complications. Blood transfusion, while beneficial, can also have adverse effects. The optimal approach to perioperative transfusion in SCD patients is still debated. This case report presents a rare surgical presentation of gallbladder stones in an SCD patient complicated by a hemolysis crisis and bleeding after laparoscopic cholecystectomy. A 24-year-old SCD patient with symptomatic gallbladder stones underwent laparoscopic cholecystectomy. Preoperative exchange transfusions were done to optimize hemoglobin and hemoglobin S (HbS) levels. Postoperatively, the patient experienced abdominal pain, tachycardia, and hypotension, indicating a possible hemolysis versus hemorrhagic crisis. Supportive management started but patient was still not improving and persisted to be tachycardic and hypotensive and laboratory results showed a drop in hemoglobin level (4.7 g/dL) and low platelets. A massive transfusion was activated and the patient received four units of packed red blood cells, four units of platelet and four units of fresh frozen plasma, but bleeding persisted. Laparoscopic exploration was done and oozing from liver bed was controlled and shifted again to surgical intensive care unit. Unfortunately, the next day, patient again experienced rebleeding which mandating laparoscopic converted to open laparotomy, and multiple sites of ongoing bleeding were identified and controlled with liver packing. The patient required subsequent interventions, including additional transfusions and second look and abdominal closure. After several days of intensive care, the patient's condition improved, and he was discharged with follow-up arrangements. Optimal management of surgical cases in SCD patients necessitates a multidisciplinary approach and personalized perioperative care. Preoperative transfusion should be tailored based on risk factors and the procedure. Standardized protocols and guidelines are needed to enhance perioperative management and outcomes. Prioritizing perioperative care can help mitigate complications and improve results for SCD patients undergoing surgery. Further research is required in this area.
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Affiliation(s)
- Abdulaziz Alshehri
- Department of General Surgery, King Fahad Military Medical Complex, Jeddah, SAU
| | - Anwar Alfadhel
- Department of General Surgery, King Fahad Military Medical Complex, Jeddah, SAU
| | - Abdullah AlZahrani
- Department of General Surgery, King Fahad Military Medical Complex, Jeddah, SAU
| | - Yousif Alqahtani
- Department of General Surgery, King Fahad Military Medical Complex, Jeddah, SAU
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Olugbogi EA, Arobadade OA, Bodun DS, Omoseeye SD, Omirin ES, Fapohunda O, Ekun OE, Metibemu DS, Shodehinde SA, Saliu JA, Omotuyi OI. Identification of apposite antagonist for androgen receptor in prostate cancer: an in silico study of fenugreek compounds. J Biomol Struct Dyn 2023:1-17. [PMID: 37897191 DOI: 10.1080/07391102.2023.2273988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
Benign Prostate Cancer (BPC), a prevalent condition predominantly affecting elderly males, manifests with voiding difficulties and urinary retention. A library of compounds from Trigonella foenum-graecum, commonly known as fenugreek was used in this study. We aimed to explore its potential anti-cancer effects by computationally assessing its inhibitory activity on the androgen receptor (AR). For in-silico drug assessment, we employed Maestro 12.8, part of the Schrödinger Suite, to identify the most promising candidates acting as androgen receptor antagonists in the treatment of BPC. Subsequently, 59 fenugreek compounds were retrieved from the PubChem database and subjected to molecular docking against the active site of the target protein, 1E3G. 100-nanosecond molecular dynamics (MD) simulations were performed to assess the stability and compactness of the AR-ligand complexes. Notably, the AR-kaempferol complex exhibited the least fluctuation within the AR active site throughout the simulation trajectory, followed by chlorogenic acid and the reference ligand, hydroxyflutamide. The MM/GBSA values revealed the compounds' maximum free binding energy (-103.3 ± 6, -87.4 ± 23, -68.5 ΔGbind) for chlorogenic acid, kaempferol, and hydroxyflutamide, respectively. These findings suggest their potential as promising leads for drug development. Further lead optimization and comprehensive studies on the top-ranked ligands identified in this investigation are warranted to advance their potential as therapeutic agents for BPC treatment.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Ezekiel A Olugbogi
- Molecular Biology and Simulation Center, Ado-Ekiti, Ekiti State, Nigeria
- Department of Biochemistry, Adekunle Ajasin University, Akungba Akoko, Ondo State, Nigeria
| | | | - Damilola S Bodun
- Molecular Biology and Simulation Center, Ado-Ekiti, Ekiti State, Nigeria
- Department of Biochemistry, Adekunle Ajasin University, Akungba Akoko, Ondo State, Nigeria
| | - Shola D Omoseeye
- Molecular Biology and Simulation Center, Ado-Ekiti, Ekiti State, Nigeria
- Department of Anatomy, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Emmanuel S Omirin
- Molecular Biology and Simulation Center, Ado-Ekiti, Ekiti State, Nigeria
| | - Oluwaseun Fapohunda
- Chemistry and Biochemistry Department, University of Arizona, Tucson, AZ, USA
| | - Oluwafemi E Ekun
- Department of Biochemistry, Adekunle Ajasin University, Akungba Akoko, Ondo State, Nigeria
| | - Damilohun S Metibemu
- Department of Biochemistry, Adekunle Ajasin University, Akungba Akoko, Ondo State, Nigeria
| | - Sidiqat A Shodehinde
- Department of Biochemistry, Adekunle Ajasin University, Akungba Akoko, Ondo State, Nigeria
| | - Jamiyu A Saliu
- Department of Biochemistry, Adekunle Ajasin University, Akungba Akoko, Ondo State, Nigeria
| | - Olaposi I Omotuyi
- Molecular Biology and Simulation Center, Ado-Ekiti, Ekiti State, Nigeria
- College of Pharmacy Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
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Aggarwal P, Bhat D. Genetic counseling in sickle cell disease: Insights from the Indian tribal population. J Community Genet 2023; 14:345-353. [PMID: 37540483 PMCID: PMC10444709 DOI: 10.1007/s12687-023-00661-z] [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: 03/07/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited disorder of hemoglobin. With an overall prevalence of 4.3%, India is the second-largest hub of SCD after Africa. Genetic counseling (GC) is the most cost-effective intervention to reduce the burden of a genetic disease including SCD. Even though GC's role in reducing SCD birth prevalence is well established, it is still not incorporated into Indian national policy and is unavailable to most Indians approaching their marriageable age and childbirth. GC perception and efficacy have also not been explored yet among young adults, especially in Indian tribal communities. Counseling in these communities requires careful consideration of their socioeconomic, cultural, and ethical values. Community engagement with local tribes and healthcare infrastructure in a multitier approach is essential for an effective GC. This review aims to provide healthcare providers and genetic counselors with the essentials of GC in the prevention and management of SCD among tribal communities based on the author's counseling experience in South India.
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Affiliation(s)
- Pooja Aggarwal
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education & Research, Mysore, Karnataka, India
| | - Deepa Bhat
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education & Research, Mysore, Karnataka, India.
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Naramreddy S, Varma A, Taksande A, Meshram RJ. The Role of Antiplatelet in the Management of Sickle Cell Disease Patients. Cureus 2023; 15:e42058. [PMID: 37602132 PMCID: PMC10434724 DOI: 10.7759/cureus.42058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Sickle cell disease (SCD) is a genetic disorder characterized by abnormal hemoglobin, leading to red blood cell deformities and subsequent vaso-occlusive events. Platelet activation and adhesion play a significant role in the pathophysiology of SCD, contributing to the development of complications such as vaso-occlusive events, stroke, acute chest syndrome, and other manifestations. Antiplatelet therapy has emerged as a potential strategy to mitigate these complications by modulating the platelet function and reducing thrombotic events. This review article provides an overview of antiplatelet therapy's role in managing SCD patients. It discusses the pathophysiological abnormalities in the platelet function in SCD, the rationale for antiplatelet therapy, and the evidence supporting its use in various clinical scenarios. The article explores aspirin as the primary antiplatelet agent in SCD, including its mechanism of action, dosing considerations, and efficacy and safety data. Additionally, it highlights other antiplatelet agents, such as clopidogrel, prasugrel, ticagrelor, and emerging therapies under investigation. Clinical applications of antiplatelet therapy in primary and secondary prevention and the management of acute chest syndrome and other SCD complications are also discussed. Safety considerations are emphasized, including bleeding risk assessment, monitoring, and patient selection for antiplatelet therapy. Finally, the review highlights future research and clinical practice directions, including the development of novel antiplatelet agents, combination therapies, and the integration of antiplatelet therapy with other SCD treatments. Overall, this review provides a comprehensive understanding of the current role of antiplatelet therapy in SCD management, the challenges faced, and future directions for improving patient outcomes.
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Affiliation(s)
- Sudheeshreddy Naramreddy
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Varma
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Isa H, Okocha E, Adegoke SA, Nnebe-Agumadu U, Kuliya-Gwarzo A, Sopekan A, Ofakunrin AO, Ugwu N, Hassan AA, Ohiaeri C, Madu A, Diaku-Akinwumi I, Ekwem L, Dogara LG, Okoh D, Jasini J, Girei A, Ekwere T, Okolo A, Kangiwa U, Lawson J, Chianumba R, Brown B, Akinola N, Nwegbu M, Nnodu O. Strategies to improve healthcare services for patients with sickle cell disease in Nigeria: The perspectives of stakeholders. Front Genet 2023; 14:1052444. [PMID: 36816043 PMCID: PMC9936139 DOI: 10.3389/fgene.2023.1052444] [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: 09/23/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background: Sickle cell disease (SCD) continues to pose physical and psychosocial burdens to patients, caregivers and health workers. Stakeholder engagement in the processes of policy making and implementation is increasingly becoming the cornerstone of best practices in healthcare. Aim and Objectives: To engage stakeholders with a view to assessing the knowledge of SCD; ascertain the challenges associated with accessibility and affordability of healthcare services; improve the quality of care, and thereby effect behavioral change through increasing attendance and follow-up of patients in the clinics. Methodology: A Stakeholders' Engagement meeting organized by the Sickle Pan Africa Research Consortium Nigeria Network (SPARC-NEt) was attended by patients, caregivers and members of patient support groups, healthcare providers and management/policymakers. The engagement was through PowerPoint presentations, structured questionnaires and an interactive session. The structured questionnaire assessed the knowledge of stakeholders about SCD; the quality of healthcare services; challenges with access and affordability; and SCD-related government policies. Results: Three hundred and twelve stakeholders attended the engagement meeting. Of the 133 that participated in the study, medical workers were the most represented. The majority had good knowledge of what causes SCD (96.2%) and the best place to get help during SCD crisis (98.5%). However, knowledge of the specific preventive measures of SCD and its crisis was not optimal. In terms of the role of community engagement and education, only about one-quarter of the study participants, 34 (25.6%) knew about their positive role in reducing the prevalence of SCD and alleviating SCD crises. Challenges identified include inadequate healthcare personnel and facilities, delay in obtaining laboratory results, long waiting time in the clinic, poor communication, absence of holistic consultation, uncoordinated healthcare services, high cost of care, ignorance, non-prioritization of SCD by government, lack of multisectoral collaboration and partnership with NGOs and international organizations. Strategies proffered to improve healthcare services include, community/stakeholder engagement and health education, sickle cell daycare services, access to a willing and dedicated multidisciplinary workforce, collaboration with support groups and government policies and programs. Conclusion: There is need for regular stakeholder engagement to improve access to healthcare services for SCD patients in Nigeria.
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Affiliation(s)
- Hezekiah Isa
- Centre of Excellence for Sickle Cell Research and Training, University of Abuja (CESRTA) Federal Capital Territory (FCT), Abuja, Nigeria,Department of Haematology and Blood Transfusion, University of Abuja, Abuja, Nigeria,*Correspondence: Hezekiah Isa,
| | - Emmanuel Okocha
- Department of Haematology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambara State, Nigeria
| | - Samuel Ademola Adegoke
- Department of Paediatrics and Child health, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Uche Nnebe-Agumadu
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Aisha Kuliya-Gwarzo
- Department of Haematology, Aminu Kano University Teaching Hospital, Kano, Kano State, Nigeria
| | - Alayo Sopekan
- Non Communicable Disease Unit, Federal Ministry of Health, Federal Secretariat, Abuja, Nigeria
| | | | - Ngozi Ugwu
- Department of Haematology, Alex Ekweme Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Abdul-Aziz Hassan
- Department of Haematology and Blood Transfusion, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Chinatu Ohiaeri
- Department of Paediatrics, Federal Medical Centre Keffi, Keffi, Nasarawa State, Nigeria
| | - Anazoeze Madu
- Department of Haematology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
| | - Ijeoma Diaku-Akinwumi
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | - Lilian Ekwem
- Department of Paediatrics, General Hospital Nyanya, Abuja, Nigeria
| | - Livingstone Gayus Dogara
- Departments of Haematology and Blood Transfusion, Kaduna State University Teaching Hospital, Kaduna, Kaduna State, Nigeria
| | - Dorothy Okoh
- Department of Haematology, Rivers State University, Port Harcourt, Rivers State, Nigeria
| | - James Jasini
- Department of Haematology, Federal Medical Centre, Yola, Adamawa State, Nigeria
| | - Ahmed Girei
- Department of Haematology, Federal Teaching Hospital Gombe, Gombe, Gombe State, Nigeria
| | - Timothy Ekwere
- Department of Haematology, University of Uyo, Uyo, Akwa IbomState, Nigeria
| | - Angela Okolo
- Federal Medical Centre Asaba, Asaba, Delta State, Nigeria
| | - Umar Kangiwa
- Department of Haematology, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria
| | - Juliet Lawson
- Department of Paediatrics, Zankli Medical Centre, Abuja, Nigeria
| | - Reuben Chianumba
- Centre of Excellence for Sickle Cell Research and Training, University of Abuja (CESRTA) Federal Capital Territory (FCT), Abuja, Nigeria
| | - Biobele Brown
- Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Norah Akinola
- Department of Haematology, Obafemi Awolowo University Teaching Hospital, Ile Ife, Osun State, Nigeria
| | - Maxwell Nwegbu
- Centre of Excellence for Sickle Cell Research and Training, University of Abuja (CESRTA) Federal Capital Territory (FCT), Abuja, Nigeria,Department of Chemical Pathology, University of Abuja, Abuja, Nigeria
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Research and Training, University of Abuja (CESRTA) Federal Capital Territory (FCT), Abuja, Nigeria,Department of Haematology and Blood Transfusion, University of Abuja, Abuja, Nigeria
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17
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Ezenwosu OU, Chukwu BF, Uwaezuoke NA, Ezenwosu IL, Urom KO, Udorah MI, Ikefuna AN, Emodi IJ. Assessment of depression in children and adolescents with sickle cell anemia in a low-resource setting: a comparative study. Pediatr Hematol Oncol 2023; 40:40-50. [PMID: 35838017 DOI: 10.1080/08880018.2022.2071510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Children with sickle cell anemia (SCA) usually face psychological complications especially depression. Assessment of depression in resource-limited settings may help identify the extent to which the children with SCA in such settings may need its introduction as part of routine care. This study aimed to assess depression in children and adolescents with SCA in a low-resource setting. This cross-sectional observational study involved 84 children and adolescents with SCA aged 7-17 years who were selected using a systematic random sampling technique. Their controls were 84 age- and sex-matched individuals with AA hemoglobin genotype. A structured questionnaire was used to collect socio-demographic data while depression was assessed with the Children's Depression Inventory. The prevalence of depression was non-significantly higher in subjects compared to the controls (8.3% vs. 2.4%) (Fisher's χ2 = 1.88, p = 0.171). Though not statistically significant, the subjects had 3.7 times higher odds of having depression compared to the controls (OR = 3.7; 95% CI 0.75-18.50; p = 0.107). Of the 5 depression subscales, the subjects had a significantly higher difference in the negative mood (p = 0.042). Despite the comparable prevalence of depression with their normal controls, children and adolescents with SCA had a higher negative mood and higher odds of having depression than normal individuals. Thus, there is a need for the introduction of depression assessment as a complement to routine care of these children with SCA in resource-poor settings.
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Affiliation(s)
- Osita U Ezenwosu
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria.,Institute of Maternal and Child Health, University of Nigeria, Enugu, Nigeria.,University of Nigeria, Centre for Translational and Implementation Research, Enugu, Nigeria
| | - Barth F Chukwu
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Ndubuisi A Uwaezuoke
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Ifeyinwa L Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Kelechi O Urom
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
| | | | - Anthony N Ikefuna
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Ifeoma J Emodi
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
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Bin Zuair A, Aldossari S, Alhumaidi R, Alrabiah M, Alshabanat A. The Burden of Sickle Cell Disease in Saudi Arabia: A Single-Institution Large Retrospective Study. Int J Gen Med 2023; 16:161-171. [PMID: 36659915 PMCID: PMC9844992 DOI: 10.2147/ijgm.s393233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Purpose Sickle cell disease (SCD) is a significant burden for patients and healthcare systems due to multiple factors, including high readmission rates. This study aimed to determine the general characteristics, etiology of admissions, annual admission rate, length of stay, and readmission rate of patients with SCD. Patients and Methods This retrospective observational study included all adult patients with SCD admitted to the General Internal Medicine (GIM) unit between 2016 and 2021. Results There were 160 patients (mean age, 31.08 ± 9.06 years; 51.25% female) with SCD included in this study. Most originated from southern Saudi Arabia (45.62%). The average annual number of emergency department (ED) visits was 4, and approximately 19% of patients had ≥3 annual admissions. The mean length of stay was 6 days. The readmission rates at 7, 30, 60, and 90 days were 8%, 24.5%, 13.6%, and 10.8%, respectively. Conclusion SCD generates a significant economic burden on the Saudi society and the effects on the healthcare system and patients' quality of life are evident in the high ED visits, readmission rates and prolonged hospitalization. Thereupon we advocate the implementation of sickle cell disease-specialized multidisciplinary clinics.
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Affiliation(s)
- Amerah Bin Zuair
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia,Correspondence: Amerah Bin Zuair, Internal Medicine, King Saud University Medical City, Riyadh, Saudi Arabia, Tel +966558765609, Email
| | - Sheikhah Aldossari
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Rand Alhumaidi
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Maha Alrabiah
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Alshabanat
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
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Lumbala PK, Mbayabo G, Ngole MN, Lumaka A, Race V, Matthijs G, Van Geet C, Lukusa PT, Devriendt K, Mikobi TM. Clinical and laboratory characterization of adult sickle cell anemia patients in Kinshasa. PLoS One 2022; 17:e0278478. [PMID: 36525434 PMCID: PMC9757547 DOI: 10.1371/journal.pone.0278478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Sickle cell anemia (SCA) is a monogenic hemoglobinopathy associated with severe acute and chronic complications, with the highest incidence worldwide in Sub-Saharan Africa. The wide variability in clinical manifestations suggest that a uniform response to hydroxurea may not be attained. In view of a potential treatment with hydroxyurea (HU), we assessed the variability of clinical and hematological manifestations in a cohort of adults with SCA in Kinshasa, capital of the DR Congo in Central Africa. METHODS A cross-sectional study was conducted in a hospital dedicated to SCA management in Kinshasa. Clinical history of patients was recorded, a complete physical examination performed. The diagnosis was confirmed by means of DNA analysis. A full blood count and hemolysis markers were measured. The severity of the disease was evaluated by means of a previously reported score. RESULTS The study group consisted of 166 genetically confirmed SCA patients. The SCA severity was mild in 28.9%, moderate in 64.5% and severe in 6.6%. The disease severity score increased with patient's age (p ≤ 0.001). The severity was higher in males compared to females (p = 0.012). In males, the severity score was correlated with the presence of priapism (p = 0.045), a manifestation not previously incorporated in the severity score. The severity score was inversely correlated with the fetal hemoglobin (HbF) rate (p = 0.005). Malnutrition (BMI <18.5 kg/m2) was present in 47% of patients and was related to the male sex, hip disease (aOR 3.11; p = 0.019) and severe phenotype (aOR 3.53; p = 0.012). Leg ulcers were more frequent in males than in females (p = 0.001; OR 24.3) and were correlated with the number of days of hospitalization (p = 0.029). Hip disease was related to the increasing age (p = 0.008). CONCLUSION In this selected, hospital-based populations of adults with SCA, severe disease was rare, which may be due to survival bias. However, two thirds had moderate severity of the disease, mostly with a low HbF, and they may benefit from HU treatment. In the Central-African setting the separation between vaso-occlusive and hyperhemolytic sub-phenotypes was not applicable.
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Affiliation(s)
| | - Gloire Mbayabo
- Department of Pediatrics, University of Kinshasa, Kinshasa, DRC
| | - Mamy Nzita Ngole
- Department of Clinical Biology, University of Kinshasa, Kinshasa, DRC
| | - Aimé Lumaka
- Faculty of Medicine, Center of Human Genetics, University of Kinshasa, Kinshasa, DRC
| | - Valerie Race
- Center for Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Gert Matthijs
- Center for Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Chris Van Geet
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | | | - Koenraad Devriendt
- Center for Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
- * E-mail: (KD); (TMM)
| | - Tite Minga Mikobi
- Faculty of Medicine, Center of Human Genetics, University of Kinshasa, Kinshasa, DRC
- Faculty of Medicine, Molecular Biology and Human Genetics Department of fundamental sciences, University of Kinshasa, Kinshasa, DRC
- * E-mail: (KD); (TMM)
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20
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Akingbola TS, Aworanti OW, Ogundeji SP. Audit of clinical and laboratory parameters of hemoglobin SS patients in a Nigerian teaching hospital. Ann Med 2022; 54:2921-2928. [PMID: 36371797 PMCID: PMC9665090 DOI: 10.1080/07853890.2022.2129090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The burden of Sickle cell anaemia (SCA) is huge in Sub Sahara Africa as it affects 1-2% of the population. HbSS impacts negatively on the quality of life of the sufferers. The clinical manifestations start between 3 and 5 months of life as a result of reduction in foetal hemoglobin. OBJECTIVES This study describes the clinical and laboratory characteristics of HbSS patients at presentation in steady state, vaso-occlusive and hemolytic crises states. MATERIAL AND METHOD This was a cross sectional, analytical study. Ninety HbSS participants were divided into three groups; steady state, hemolytic and vaso-occlusive crises with 30 individuals in each group. The survey contained sections on bio-data and past medical history obtained from the patients' notes and results of laboratory tests. Data were analysed using SPSS version 23.0. Results were considered statistically significant if p < 0.05. RESULTS Ninety participants were analysed in this study. The mean age of the participants was 29.4 ± 8.9 years. Only one-third of the participants were diagnosed within the first year of age. Forty-seven (52.2%) participants have steady state haematocrit in the range of 21-25%. All the participants experienced bone pain in a year, about 25% of these participants had more than three episodes of pain per year. There was a statistically significant difference in the mean values of PCV (p < .001), WBC (p < .001), platelet (p = .008), ANC (p < .001), ALC (p < .001), AMC (p < .001), reticulocyte count and ISC % among the different categories. CONCLUSION This study established the fact that only a minority of the SCD patients are diagnosed in the first year of life and vaso-occlusive crisis is the most frequent reason for hospital presentation. We therefore recommend the institutionalisation by government policy, neonatal screening programme in Nigeria.KEY MESSAGESThe study highlight delay in early diagnosis of SCA due to unavailability of neonatal diagnosis program in our setting.Bone pain remains the major cause of presentation for SCA and most patients presented after a day of onset of pain to the hospital.
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Affiliation(s)
| | - Oladapo Wale Aworanti
- Department of Hematology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Sunday Peter Ogundeji
- Department of Hematology, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Atoku AC, Nekaka R, Kagoya EK, Ssenyonga LVN, Iramiot JS, Tegu C. Psycho-social challenges faced by caretakers of children and adolescents aged 0-19 years with sickle cell disease admitted in a tertiary hospital in Eastern Uganda. J Pediatr Nurs 2022; 69:e21-e31. [PMID: 36463013 DOI: 10.1016/j.pedn.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Families of children and adolescents living with sickle cell disease face several challenges ranging from psycho-social to social-economic challenges. This study aimed to explore psycho-social challenges experienced by caretakers of children and adolescents aged 0-19 years with SCD and the various coping mechanisms. METHODS A mixed-methods cross-sectional study was carried out among caregivers of children with SCD who were admitted to the pediatric wards of the Mbale Regional Referral Hospital from September 2019 to November 2019. A total of 333 participants were interviewed using a pretested questionnaire and 11 in-depth interviews were conducted. RESULTS Most participants 285(85.59%) reported that they experienced psychological challenges and almost all the participants in this study 297(89.19%) experienced social challenges during the care of their patients. Only 36(10.81%) reported not experiencing any social challenges. Almost all the participants reported coping with the situation in various ways of which, 296(88.89%) used acceptance, 9(2.7%) still lived in denial, while 9(2.7%) used talking with others and getting counseled to reduce the intensity of the feelings experienced. Three themes were generated from the in-depth interviews; knowledge of the child's health condition; common symptoms and care, the experience of psycho-social challenges, and coping strategies. CONCLUSION Sickle cell disease has affected two sets of people; the people living with the disease and those who are caring for their loved ones. Being conscious of this will help health practitioners to be more empathetic to patients and caregivers when treating people living with sickle cell disease. The biggest proportion of caretakers of children and adolescents 0-19 years experienced psycho-social challenges. The main coping strategy used by the caretakers was acceptance.
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Affiliation(s)
| | - Rebecca Nekaka
- Department of Community Health, Division of Community Based Education and Research Services, Faculty of Health Sciences, Busitema University, Uganda
| | - Enid Kawala Kagoya
- Department of Community Health, Division of Community Based Education and Research Services, Faculty of Health Sciences, Busitema University, Uganda
| | - Lydia V N Ssenyonga
- Department of Nursing, Faculty of Health Sciences, Busitema University, Uganda
| | - Jacob Stanley Iramiot
- Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Uganda.
| | - Crispus Tegu
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Busitema University, Uganda
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22
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Aliyu Z, Kushimo OA, Oluwole AA, Amadi C, Oyeyemi N, Mbakwem A, Afolabi BB. Effects of pregnancy on cardiac structure and function in women with sickle cell anemia: a longitudinal comparative study. J Matern Fetal Neonatal Med 2022; 35:10049-10054. [PMID: 35723675 DOI: 10.1080/14767058.2022.2089549] [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: 10/18/2022]
Abstract
BACKGROUND Sickle cell anemia is the commonest hemoglobinopathy in pregnant Nigerian women, and cardiac manifestations are a significant feature of the disease especially in pregnancy. Pregnant women with sickle cell anemia are at high risk of morbidity and mortality and cardiac dysfunction in them increases this risk and may compromise their post-partum health. OBJECTIVE To evaluate the cardiac size and function in women with sickle cell anemia (HbSS) during late pregnancy and postpartum. METHODOLOGY This was a longitudinal comparative study in which 40 women, consisting of 20 pregnant HBSS and 20 pregnant HBAA women controls, were recruited. Echocardiography was performed in the third trimester of pregnancy and 6 weeks postpartum. RESULTS There was a decrease in the mean left atrial diameter (p < .001), left ventricular diameter in diastole (p = .041), and left ventricular mass (p = .004) of HBSS women in the postpartum period compared to their antepartum state. In contrast, there was no significant difference in most cardiac dimensions of pregnant vs postpartum HBAA women. There was no significant change in cardiac function in the pregnant vs postpartum states in both study groups. There were significant differences in cardiac size but not function when comparing HBSS and HBAA women in pregnancy and postpartum. CONCLUSION Changes in cardiac size of sickle cell women in pregnancy does not appear to affect cardiac function during pregnancy and in the puerperium, suggesting that the increased size may purely be a response to their chronic anemic state. Studies following women up for longer periods including those with co-morbidities are recommended.
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Affiliation(s)
- Zubaida Aliyu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oyewole A Kushimo
- Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ayodeji A Oluwole
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Casmir Amadi
- Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Nuvie Oyeyemi
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Amam Mbakwem
- Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Bosede B Afolabi
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
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23
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Alabi OJ, Adegboyega FN, Olawoyin DS, Babatunde OA. Functional foods: promising therapeutics for Nigerian Children with sickle cell diseases. Heliyon 2022; 8:e09630. [PMID: 35677416 PMCID: PMC9167986 DOI: 10.1016/j.heliyon.2022.e09630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/30/2021] [Accepted: 05/26/2022] [Indexed: 11/21/2022] Open
Abstract
Sickle cell disease (SCD), also known as sickle cell anemia (SCA) is one of the structural hemoglobinopathies that occurs due to a single nucleotide mutation from GAG to GTG, which changes the amino acid of a β-globin chain of hemoglobin (Hb) from glutamate to valine. This singular mutation results to disorderliness in red blood cells (RBCs) with advent of changes in RBC morphology and other pathological conditions. In the 1980s, intermittent red blood cell transfusions, opioids, and penicillin prophylaxis were the only available therapy for SCA and were commonly reserved for acute, life threatening complications. So far, the US Food and Drug Administration (FDA) has granted a total of four drugs approval for the prophylaxis and treatment of the clinical complications of SCD. Due to limitations (adherence, safety, adverse effects) of existing therapies in the prophylaxis and treatment of SCD complications in Nigerian children and their inaccessibility to approved drugs, the present study discusses the therapeutic effects of readily available functional food as one of the therapies or an adjunct therapy to tackle the sickle cell crisis in Nigerian Children.
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Affiliation(s)
- Oladeji John Alabi
- Department of Biochemistry, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Department of Biochemistry, Institute for Agriculture & Natural Sciences, College of Arts & Sciences, University of Nebraska-Lincoln, USA
| | - Fikayo Noah Adegboyega
- Department of Biochemistry, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Department of Biotechnology, Egypt-Japan University of Science and Technology, Alexandria, Egypt
| | - Dolapo Samuel Olawoyin
- Department of Biochemistry, Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
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24
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Adebayo OC, Van den Heuvel LP, Olowu WA, Levtchenko EN, Labarque V. Sickle cell nephropathy: insights into the pediatric population. Pediatr Nephrol 2022; 37:1231-1243. [PMID: 34050806 DOI: 10.1007/s00467-021-05126-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/10/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
The life expectancy of individuals with sickle cell disease has increased over the years, majorly due to an overall improvement in diagnosis and medical care. Nevertheless, this improved longevity has resulted in an increased prevalence of chronic complications such as sickle cell nephropathy (SCN), which poses a challenge to the medical care of the patient, shortening the lifespan of patients by 20-30 years. Clinical presentation of SCN is age-dependent, with kidney dysfunction slowly beginning to develop from childhood, progressing to chronic kidney disease and kidney failure during the third and fourth decades of life. This review explores the epidemiology, pathology, pathophysiology, clinical presentation, and management of SCN by focusing on the pediatric population. It also discusses the factors that can modify SCN susceptibility.
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Affiliation(s)
- Oyindamola C Adebayo
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.,Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lambertus P Van den Heuvel
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pediatric Nephrology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Wasiu A Olowu
- Pediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Elena N Levtchenko
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium. .,Department of Pediatric Nephrology, University Hospital Leuven, Herestraat 49, Bus 817, 3000, Leuven, Belgium.
| | - Veerle Labarque
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pediatric Hematology, University Hospital Leuven, Leuven, Belgium
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25
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Nnajekwu UC, Nnajekwu CO, Onukwuli VO, Chukwu BF, Ikefuna AN, Emodi IJ. Folate levels in children with sickle cell anaemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu, Nigeria: a prospective, comparative study. Malawi Med J 2022; 34:132-137. [PMID: 35991819 PMCID: PMC9356529 DOI: 10.4314/mmj.v34i2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Folic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis. AIM To determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype. METHOD This study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment. RESULTS The median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001). CONCLUSION Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state.
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Affiliation(s)
- Uchenna C Nnajekwu
- Department of Paediatrics, University Of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Vivian O Onukwuli
- Department of Paediatrics, University Of Nigeria Teaching Hospital, Enugu, Nigeria, Department of Paediatrics, College Of Medicine, University Of Nigeria, Enugu Campus
| | - Bartholomew F Chukwu
- Department of Paediatrics, University Of Nigeria Teaching Hospital, Enugu, Nigeria, Department of Paediatrics, College Of Medicine, University Of Nigeria, Enugu Campus
| | - Anthony N Ikefuna
- Department of Paediatrics, University Of Nigeria Teaching Hospital, Enugu, Nigeria, Department of Paediatrics, College Of Medicine, University Of Nigeria, Enugu Campus
| | - Ifeoma J Emodi
- Department of Paediatrics, University Of Nigeria Teaching Hospital, Enugu, Nigeria, Department of Paediatrics, College Of Medicine, University Of Nigeria, Enugu Campus
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26
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Dua M, Bello-Manga H, Carroll YM, Galadanci AA, Ibrahim UA, King AA, Olanrewaju A, Estepp JH. Strategies to increase access to basic sickle cell disease care in low- and middle-income countries. Expert Rev Hematol 2022; 15:333-344. [PMID: 35400264 PMCID: PMC9442799 DOI: 10.1080/17474086.2022.2063116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/04/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common hemoglobinopathy in the world. Over 90% of those born with SCD live in low- and middle-income countries (LMICs), yet individuals in these settings have much poorer outcomes compared to those in high-income countries. AREAS COVERED This manuscript provides an in-depth review of the cornerstones of basic SCD care, the barriers to implementing these in LMICs, and strategies to increase access in these regions. Publications in English language, peer-reviewed, and edited from 2000 to 2021 were identified on PubMed. Google search was used for gray literature. EXPERT OPINION Outcomes for patients with SCD in high-income countries have improved over the last few decades due to the implementation of universal newborn screening programs and use of routine antimicrobial prophylaxis, increase in therapeutic and curative options, and the adoption of specific measures to decrease risk of stroke. This success has not translated to LMICs due to several reasons including resource constraints. A combination of several strategies is needed to increase access to basic SCD care for patients in these settings.
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Affiliation(s)
- Meghna Dua
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Halima Bello-Manga
- Department of Hematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Nigeria
| | - Yvonne M. Carroll
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | | | - Allison A. King
- in Occupational Therapy, Departments of Pediatrics, Medicine and Surgery, Washington University School of MedicineProgram , St. Louis, USA
| | - Ayobami Olanrewaju
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jeremie H. Estepp
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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Pediatric Sickle Cell Disease in Sudan: Complications and Management. Anemia 2022; 2022:3058012. [PMID: 35198244 PMCID: PMC8860554 DOI: 10.1155/2022/3058012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Sickle cell disease (SCD) is a life-threatening genetic disorder due to the formation of sickle hemoglobin molecule (HbS) that polymerizes in hypoxic conditions leading to SCD-related complications. Different approaches have been used in the management of SCD including symptomatic management, supportive management, and preventive management. Objectives. To assess the management of SCD in pediatric patients in Gaafar Ibnauf Referral Hospital in Khartoum locality, Sudan. Method. A descriptive, retrospective, hospital-based study was conducted in Gaafar Ibnauf Hospital using a data collection sheet. The study included all medical files of pediatric patients with SCD attending the hospital during the period from the first of April 2018 to the first of July 2018. The data were analyzed using descriptive statistics and the chi-square test.
was considered statistically significant. Results. Out of 207 pediatric patients, 53.1% were females (mean age of 7.5 ± 3.1 years), with a 1.1 : 1 female:male ratio and low socioeconomic status. Only 4.3% of participants had health insurance. The Messeryia tribe in western Sudan had the highest prevalence of the disease among the Sudanese tribes (11.1%). Vaso-occlusive crisis (33.3%), infections (13.5%), and neurological complications (10.6%) were the most frequent complications reported during routine visits. After initiation of management, only 3.4% of pediatric patients had hemolytic crises, and 1.4% of the anemic patients had splenomegaly. 100% of patients received folic acid, 73.9% used hydroxyurea, and 69.6% underwent blood transfusion for the management of SCD. Prophylactic penicillin was prescribed for 15% of patients, and 41.1% were immunized with pneumococcal vaccine (PPSV23). Most patients had been scheduled for planned follow-up visits every 3–6 months (93.2%). Hydroxyurea and blood transfusion significantly reduced fever and vaso-occlusive crisis. Conclusion. The SCD treatment protocol in Gaafar Ibnauf Children’s Hospital, involving preventive and symptomatic therapy, is consistent with the internationally implemented protocols for SCD management. However, immunization and prophylactic penicillin approaches are deficient.
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Pentazocine Misuse among Sickle Cell Disease Patients and The Role of Lack of Enforcement of Opioid Dispensing Regulations by Community Pharmacies: A Descriptive Observational Study. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3877882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Sickle cell disease (SCD) is a chronic disease characterized by debilitating bone pains which commonly necessitate the use of analgesic drugs including opioids and psychotropic substances such as pentazocine which are controlled medicines in Nigeria. Opioid misuse including dependence and addiction is an increasing trend among SCD patients, and it has serious adverse implications on their social, economic, and physical well-being. The role of lack of implementation of existent regulation on the dispensing of opioids by pharmacies has not been adequately investigated. Objective. The primary objective of this study is to define the sociodemographic and clinical implications of pentazocine misuse among patients with SCD and to describe the contributions of lack of enforcement of opioid dispensing regulations to this menace. Materials and Methods. The study was a descriptive observational study. A 29-item pretested and prevalidated questionnaire was administered to 21 SCD patients with an established history of pentazocine misuse and addiction to establish their demographics, details of opioid use, and their clinical effects. Nine community pharmacies were interviewed to ascertain their knowledge of controlled medicines and their compliance to existent regulations on the dispensation of opioids. Results. The median (interquartile range) age of the SCD subjects was 24 years. The majority of subjects (14, 66.7%) had tertiary education. Fifteen (71.4%) of them had a history of pentazocine misuse for over two years. All subjects source pentazocine injection from local pharmacies and patent medicine shops without prescription, while 19.0% get home deliveries. Seventeen (80.9%) of the SCD subjects desired to discontinue the habit; however, inadequate medical support was reported to contribute to their inability to overcome this practice in 14 (54.3%) patients. Most of the local pharmacies/drug shop proprietors are aware of drug laws guiding controlled medicines in Nigeria. However, about 77.9% of pharmacies interviewed retail pentazocine without prescription. A lack of enforcement by the state and federal taskforce was reported to contribute to this practice. Conclusion. Pentazocine misuse is a serious problem in patients with SCD. Inadequate medical support and lack of enforcement of regulations on dispensing opioids by community pharmacies are contributors to this menace.
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Okeke C, Silas U, Nnodu O, Clementina O. HSC and miRNA Regulation with Implication for Foetal Haemoglobin Induction in Beta Haemoglobinopathies. Curr Stem Cell Res Ther 2022; 17:339-347. [PMID: 35189805 DOI: 10.2174/1574888x17666220221104711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/29/2021] [Accepted: 12/08/2021] [Indexed: 11/22/2022]
Abstract
Sickle cell disease (SCD) is one of the most common haemoglobinopathies worldwide, with up to 70 % of global SCD annual births occurring in sub-Saharan Africa. Reports have shown that 50 to 80 % of affected children in these countries die annually. Efforts geared towards understanding and controlling HbF production in SCD patients could lead to strategies for effective control of globin gene expression and therapeutic approaches that could be beneficial to individuals with haemoglobinopathies. Hemopoietic stem cells (HSCs) are characterized by a specific miRNA signature in every state of differentiation. The role of miRNAs has become evident both in the maintenance of the "stemness" and in the early induction of differentiation by modulation of the expression of the master pluripotency genes and during early organogenesis. miRNAs are extra regulatory mechanisms in hematopoietic stem cells (HSCs) via influencing transcription profiles together with transcript stability. miRNAs have been reported to be used to reprogram primary somatic cells toward pluripotency. Their involvement in cell editing holds the potential for therapy for many genetic diseases. This review provides a snapshot of miRNA involvement in cell fate decisions, haemoglobin induction pathway, and their journey as some emerge prime targets for therapy in beta haemoglobinopathies.
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Affiliation(s)
- Chinwe Okeke
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, University of Nigeria, Nsukka, Nigeria
| | - Ufele Silas
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, University of Nigeria, Nsukka, Nigeria
| | - Obiageli Nnodu
- Department of Haematology, College of Medicine, University of Abuja, Abuja Nigeria
| | - Odoh Clementina
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, University of Nigeria, Nsukka, Nigeria
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30
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Mkoka DA, Nkingi R. Lived Experiences of Adults with Sickle Cell Disease: A Qualitative Study, Dar es Salaam, Tanzania. East Afr Health Res J 2022; 6:189-195. [PMID: 36751678 PMCID: PMC9887503 DOI: 10.24248/eahrj.v6i2.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/25/2022] [Indexed: 01/02/2023] Open
Abstract
Background Sickle Cell Disease (SCD) is most common genetic disorder and its prevalence in sub-Saharan Africa is increasing. Despite increased survival rates, experiences of adults living with SCD in Tanzania is not well explored. This article provides perceived causes of pain crisis, pain self-management approaches and psychosocial implication of SCD. Aim This study aimed at exploring experiences of adults living with SCD regarding pain triggering or aggravating factors; self-management for pain; psychosocial-economical implication of SCD and coping mechanism used by individuals living with SCD. Methods A qualitative study design was chosen using in-depth interviews with adults living with SCD to explore their experience of living with SCD. Fifteen adults aged 18 years and above living with SCD were interviewed. Data were analyzed by using content analysis approach. Findings Four categories emerged that described experiences of individuals with SCD. The four categories are; "Pain Triggering and Aggravating Factors" describing participants' perceived factors causing pain in SCD; "Self-care remedies for the pain" referring to participants' methods for self-management of pain; "Psychosocial-economic impact of illness" referring to participants' experience of implication of illness on social and economic life and "Dealing and coping with illness" referring to experience of participants on management and coping strategies used to live with the illness. Conclusion Individuals with SCD experiences several episodes of pain that affect their quality of life. Pain episode can be triggered or aggravated by various factors. Several approaches are used by individuals with SCD to self-manage the pain including taking rest, drinking plenty of water or using pain relieving medication. Care for individuals with SCD should be comprehensive and include proper management of pain, health education on home-based intervention for sickle cell pain, supportive services to deal with psychosocial implications of SCD and improving coping strategies to live with the illness.
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Affiliation(s)
- Dickson Ally Mkoka
- Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania,Correspondence to Dickson A Mkoka ()
| | - Rehema Nkingi
- Critical Care Nurse Specialist, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
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31
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Ayevbuomwan ME, Elekofehinti OO, Obuseh FA, Omoregie ES. Antisickling potential of compounds derived from Detarium microcarpum (Fabaceae): in vitro and in silico studies. ADVANCES IN TRADITIONAL MEDICINE 2021. [DOI: 10.1007/s13596-020-00498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Ezenwosu O, Chukwu B, Ezenwosu I, Uwaezuoke N, Eke C, Udorah M, Idoko C, Ikefuna A, Emodi I. Clinical depression in children and adolescents with sickle cell anaemia: influencing factors in a resource-limited setting. BMC Pediatr 2021; 21:533. [PMID: 34847910 PMCID: PMC8638467 DOI: 10.1186/s12887-021-03015-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Sickle cell anaemia (SCA) is the commonest monogenic haematologic disorder resulting from the inheritance of homozygous mutant haemoglobin genes from both parents. Some factors have been identified as important in explaining the variability in depression in sickle cell anaemia (SCA). Information on this is limited in a resource-limited setting like Nigeria. This study aims to determine factors which influence depression in children and adolescents with sickle cell anaemia in a resource-limited setting. Methods Systematic random sampling technique was used in this cross-sectional study to select children and adolescents aged 7–17 years at the weekly sickle cell clinic of the University of Nigeria Teaching hospital (UNTH) Enugu, Nigeria. Pretested, structured questionnaire was used to collect sociodemographic and disease severity data while depression was assessed using the Children’s Depression Inventory. Results Age and educational level had significant positive linear relationships with depression (r = 0.253, p = 0.02; r = 0.225, p = 0.04 respectively) while gender (χ2 = 0.531, p = 0.466), socioeconomic status (χ2 = 0.451, p = 0.798) and disease severity (χ2 = 0.422, p = 0.810) had no relationship with depression in children and adolescents with SCA. Conclusion Depression in children and adolescents with SCA increased with increasing age and educational level. Psychological evaluation should be integrated into routine assessment of children with SCA during their follow up visits as they get older and progress in class.
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Affiliation(s)
- Osita Ezenwosu
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria. .,Institute of Maternal and Child Health, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria. .,Centre for Translational and Implementation Research, University of Nigeria, Enugu, Nigeria.
| | - Barth Chukwu
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Ifeyinwa Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ndubuisi Uwaezuoke
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Christopher Eke
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Maria Udorah
- Department of Paediatrics, Annunciation Specialist Hospital, Emene, Enugu, Nigeria
| | - Chinedu Idoko
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Anthony Ikefuna
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Ifeoma Emodi
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
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Bamgbade OA, Onongaya V, Anomneze-Collins A, Omoniyi DA, Simmonds-Brooks P, Richards RN. Delayed surgical diagnosis and treatment of severe sickle cell arthropathy: The need to raise clinicians' awareness. J Taibah Univ Med Sci 2021; 16:683-688. [PMID: 34690647 PMCID: PMC8498693 DOI: 10.1016/j.jtumed.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 10/25/2022] Open
Abstract
Objectives Sickle cell disease (SCD) is associated with femoral head osteonecrosis and is treated with hip arthroplasty 18 weeks after presentation. However, there is inadequate data regarding the timing of surgical management of severe hip arthropathy. This study explores the problem of delayed diagnosis and surgical management of severe SCD hip arthropathy by comparing the clinical outcomes of patients from Nigeria, Canada and Britain. Methods This is a prospective clinical audit of the routine care of 30 adult SCD patients who underwent hip arthroplasty for femoral head osteonecrosis. The clinical data are collected from five medical centers in Britain, Canada and Nigeria and compared. Results Hip arthroplasty was delayed beyond 18 weeks in 3 of 14 Nigerian patients (21%), 7 of 10 British patients (70%) and all 6 Canadian patients (100%). The majority of Nigerian patients (79%) and only 30% of British patients had diagnostic imaging and surgical management without delay. Conclusion Inadequate physician awareness and delayed surgical management of SCD hip arthropathy can be mitigated by improving the education of physicians who manage patients with SCD. It is essential to recruit, train and support physicians with an interest in SCD. As this primarily affects young patients, it is necessary to set an international standard for the timing of surgical management of SCD hip arthropathy.
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Affiliation(s)
| | - Vera Onongaya
- Department of Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Adanna Anomneze-Collins
- Department of Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | | | - Patrice Simmonds-Brooks
- Sickle Cell Department, Sickle Cell Unit, Caribbean Institute for Health Research, UWI, Kingston, Jamaica
| | - Renee N Richards
- Research Department, Salem Anaesthesia Pain Clinic Surrey, Vancouver, BC, Canada
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Ayankunle AA, Wakeel OK, Kolawole OT, Oyekale AO, Ojurongbe O, Adeyeba OA. Drug Repositioning: Antimalarial Activities of GABA Analogs in Mice Infected with Plasmodium berghei. Cent Nerv Syst Agents Med Chem 2021; 20:110-121. [PMID: 32496991 DOI: 10.2174/1871524920666200604151907] [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: 12/18/2019] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Drug repositioning is becoming popular due to the development of resistance to almost all the recommended antimalarials. Pregabalin and gabapentin are chemical analogs of gamma- aminobutyric acid (GABA) approved for the treatment of epilepsy and neuropathic pain. OBJECTIVE This study investigates acute toxicities and antimalarial activities of pregabalin and gabapentin in the murine malarial model. METHODS Acute toxicities were assessed using the method of Lorke, while curative activities were assessed by the administration of serial doses of pregabalin and gabapentin to Plasmodium berghei infected mice. Pregabalin was further investigated for its prophylactic activity, and curative potential when combined with either artesunate or amodiaquine. All drugs were freshly prepared and administered orally. Thin films were collected, stained, and observed under the microscope for the estimation of parasitemia and calculation of percentage chemoinhibition or chemoprevention. In pregabalin -artesunate or -amodiaquine combination aspect of this study, survival day post-infection (SDPI) was recorded, while parasitemia was re-estimated for animals that survived till day 28. RESULTS The oral LD50 of gabapentin, as well as pregabalin, was >5,000 mg/kg. Gabapentin at 100 and 200 mg/Kg demonstrated 35.64% and -12.78% chemoinhibition, respectively, while pregabalin demonstrated 75.60% and 100.00% chemoinhibition at doses of 12.5 and 25 mg/Kg, respectively. Moreover, pregabalin at individual doses of 25, 50 mg/Kg, and in combination with either artesunate or amodiaquine demonstrated 100.00% chemoinhibition. In its prophylactic study, pregabalin was found to be 100% chemopreventive at individual doses of 12.5 and 25 mg/Kg. CONCLUSION Both GABA analogs have antimalarial properties, but pregabalin proved to be more efficacious.
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Affiliation(s)
- Akeem A Ayankunle
- Department of Pharmacology and Therapeutics, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Olayemi K Wakeel
- Department of Pharmacology and Therapeutics, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Oyetunji T Kolawole
- Department of Pharmacology and Therapeutics, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Adesola O Oyekale
- Department of Chemical Pathology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Olusola Ojurongbe
- Department of Medical Microbiology & Parasitology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Oluwaseyi A Adeyeba
- Department of Medical Microbiology & Parasitology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
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Prevalence of Stroke in Asian Patients with Sickle Cell Anemia: A Systematic Review and Meta-Analysis. Neurol Res Int 2021; 2021:9961610. [PMID: 34150339 PMCID: PMC8195673 DOI: 10.1155/2021/9961610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
Sickle cell anemia (SCA) is an inherited autosomal recessive disease. It is caused due to point mutation that substitutes glutamate with valine at the sixth amino acid position of the beta chain of hemoglobin molecules leading to the sickling of the red blood cells and decreased structural deformability. Silent cerebral infarcts are the most common neurological complication of SCA, while overt stroke comprises substantial burden in patients with SCA. This meta-analysis aimed to find the pooled prevalence of overt stroke in SCA patients and discuss the importance of screening them. PubMed, Embase, and Google Scholar were the electronic databases used to search the studies. A total of 765 articles were retrieved upon detailed searching in the abovementioned databases. After a series of removing duplicate articles, title and abstract screening, and full-text review, 20 articles were found eligible and included in the study. The total number of participants from all the included studies was 3,956, and pooled prevalence of stroke in patients with sickle cell anemia in Asia was found to be 5% (95% CI: 4%, 6%) with a range from 1 to 41%. Stroke occurrence in sickle cell anemia patients is an emergency complication that needs immediate intervention and management. Because of the high prevalence of stroke in patients with sickle cell anemia, clinicians should focus on its prevention and treatment strategies.
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Nnebe-Agumadu U, Adebayo I, Erigbuem I, James E, Kumode E, Nnodu O, Adekile A. Hydroxyurea in children with sickle cell disease in a resource-poor setting: Monitoring and effects of therapy. A practical perspective. Pediatr Blood Cancer 2021; 68:e28969. [PMID: 33788390 DOI: 10.1002/pbc.28969] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/30/2021] [Accepted: 02/07/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although effectiveness of hydroxyurea (HU) in sickle cell disease is well established, unanswered questions persist about its use in African children. We determined real-life issues of acceptability, availability, and monitoring of HU use in Nigeria. METHODS A retrospective longitudinal review of laboratory data of patients on HU was done from case files, followed by a cross-sectional survey that captured families' perception of medication and clinic adherence, laboratory tests, benefits, side effects, and acceptability. RESULTS One hundred sixteen patients (1.2-17 years) received HU (mean ± SD = 18.5 ± 4.3 mg/kg/day) in 33 months. Eighty-nine had laboratory analysis. Dose escalation was the initial goal, but only 80% of patients had some form of it. Parents reported improvement in general well-being and reduction in bone pain episodes, hospital admissions, and blood transfusion. While most parents (89.5%) reported satisfaction with HU, 61% reported dissatisfaction with daily drug use, and the frequency and cost of monitoring. Sixteen percent voluntarily stopped therapy. Adherence to daily HU was 88.8%, doctor's appointments 24.5%, hematology tests 18.9%, and organ function tests 37.4%. There were no significant toxicities. Significant increases in hemoglobin, hemoglobin F and mean corpuscular volume, and reduction in absolute neutrophil count occurred despite inconsistent dose escalation. CONCLUSION HU (10-15 mg/kg/day starting dose) is safe and seems effective and acceptable to parents. Parental commitment to therapy, pre-HU education (that continues during therapy), provision of affordable HU, and subsidized laboratory tests are important considerations for initiating therapy. Special HU clinics may facilitate dose escalation and reduce frequency of monitoring. Studies are needed on feasibility of maximum tolerable dose HU protocols in sub-Saharan Africa without compromising safety.
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Affiliation(s)
- Uche Nnebe-Agumadu
- Department of Paediatrics, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Innocent Adebayo
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Ifeanyi Erigbuem
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Esther James
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Evelyn Kumode
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Obiageli Nnodu
- Department of Hematology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Adekunle Adekile
- Department of Paediatrics, Kuwait University, Kuwait City, Kuwait
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Nnajekwu UC, Nnajekwu CO, Onukwuli VO, Uwaezuoke NA, Ezenwosu OU, Ikefuna AN, Emodi IJ. Relationship between disease severity and folate status of children with sickle cell anaemia in Enugu, South East Nigeria. Afr Health Sci 2021; 21:759-764. [PMID: 34795733 PMCID: PMC8568239 DOI: 10.4314/ahs.v21i2.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Repeated crises in children with sickle cell anaemia (SCA), which is a manifestation of disease severity, results in depletion of their minimal tissue folate stores, with higher likelihood of folate deficiency. The study aimed to determine the relationship between disease severity and the folate status of children with SCA attending University of Nigeria Teaching Hospital (UNTH), Enugu. Methods This was a hospital based, cross-sectional study conducted between September 2018 and March 2019. One hundred participants were recruited, consisting of 50 children having sickle cell crisis and 50 age and gender matched haemoglobin AA genotype controls. Relevant information was documented using a pretested questionnaire. Sickle cell severity score was determined using frequency of crisis, admissions and transfusions in the preceding one year, degree of liver and splenic enlargement, life-time cummulative frequency of specific complications of SCA, leucocyte count and haematocrit. Results Folate deficiency was observed in eight percent of the subjects and none of the controls. The difference was not significant (Fisher's exact = 4.167, p=0.117). The odds of being folate deficient was 8.5 times more likely during anaemic crisis than in vaso-occlusive crisis, though not significant (95% C.I 0.05 – 89.750, p = 0.075). The mean SCA severity score was 8.06 ± 3.64, signifying a moderate SCA severity in the study population. There was a no relationship between folate status and severity of SCA (Fisher's exact = 0.054, p = 0.949) Conclusion Folate status in children with SCA is not affected by their disease severity. Therefore, there may be no need for additional folate supplementation with increasing severity of sickle cell anaemia.
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Affiliation(s)
- Uchenna C Nnajekwu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Vivian O Onukwuli
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Department of Paediatrics, College of Medicine, University Of Nigeria, Enugu Campus
| | - Ndubuisi A Uwaezuoke
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Department of Paediatrics, College of Medicine, University Of Nigeria, Enugu Campus
| | - Osita U Ezenwosu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Department of Paediatrics, College of Medicine, University Of Nigeria, Enugu Campus
| | - Anthony N Ikefuna
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Department of Paediatrics, College of Medicine, University Of Nigeria, Enugu Campus
| | - Ifeoma J Emodi
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Department of Paediatrics, College of Medicine, University Of Nigeria, Enugu Campus
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Evaluation of the expression of red blood cell CD36, interleukin-6 and interleukin-8 in sickle cell anemia pediatric patients. Cytokine 2021; 143:155534. [PMID: 33888402 DOI: 10.1016/j.cyto.2021.155534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/08/2021] [Accepted: 04/01/2021] [Indexed: 02/02/2023]
Abstract
Sickle cell anemia (SCA) is a complex multisystem disease characterized by acute and chronic inflammation, with alterations in inflammatory cytokines and adhesion molecules. This case-control study was carried out to assess the levels of CD36, immature reticulocytes, interleukin (IL)-6 and IL8 in SCA patients (in crisis and the steady state) and healthy controls. It included 90 children who were 2-18 years old; 60 with SCA and 30 healthy controls. Complete blood count, total reticulocyte count, reticulocyte subpopulations, immature reticulocyte fraction (IRF), percentage of CD36-positive red blood cells (RBCs), IL-6 and IL-8 levels were evaluated. The total white blood cell (WBC) and neutrophil counts, CD36-positive RBCs percentage, IRF, IL-6 and IL-8 levels were significantly higher in crises than in the steady state (P < 0.05). We also found that patients with SCA had significantly higher reticulocyte, WBC and neutrophil counts, fetal hemoglobin, CD36-positive RBCs percentage, IRF, and IL-6 and IL-8 levels than healthy children (P < 0.05). A significant positive linear correlation was reported between IL-6 and neutrophils during crises (Spearman correlation coefficient = 0.397, P = 0.03). These findings suggest that the levels of adhesion molecules and inflammatory markers and IRF, as evidenced by CD36-positive RBCs, IL-6 and IL-8, are elevated in SCA patients, both during steady state and crises, although these elevations are more marked during crises. Further knowledge about these cytokines and adhesion molecules will help in understanding the pathogenesis and improve therapy of SCA.
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Gyamfi J, Ojo T, Epou S, Diawara A, Dike L, Adenikinju D, Enechukwu S, Vieira D, Nnodu O, Ogedegbe G, Peprah E. Evidence-based interventions implemented in low-and middle-income countries for sickle cell disease management: A systematic review of randomized controlled trials. PLoS One 2021; 16:e0246700. [PMID: 33596221 PMCID: PMC7888630 DOI: 10.1371/journal.pone.0246700] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite ~90% of sickle cell disease (SCD) occurring in low-and middle-income countries (LMICs), the vast majority of people are not receiving evidence-based interventions (EBIs) to reduce SCD-related adverse outcomes and mortality, and data on implementation research outcomes (IROs) and SCD is limited. This study aims to synthesize available data on EBIs for SCD and assess IROs. METHODS We conducted a systematic review of RCTs reporting on EBIs for SCD management implemented in LMICs. We identified articles from PubMed/Medline, Global Health, PubMed Central, Embase, Web of Science medical subject heading (MeSH and Emtree) and keywords, published from inception through February 23, 2020, and conducted an updated search through December 24, 2020. We provide intervention characteristics for each study, EBI impact on SCD, and evidence of reporting on IROs. MAIN RESULTS 29 RCTs were analyzed. EBIs identified included disease modifying agents, supportive care agents/analgesics, anti-malarials, systemic treatments, patient/ provider education, and nutritional supplements. Studies using disease modifying agents, nutritional supplements, and anti-malarials reported improvements in pain crisis, hospitalization, children's growth and reduction in severity and prevalence of malaria. Two studies reported on the sustainability of supplementary arginine, citrulline, and daily chloroquine and hydroxyurea for SCD patients. Only 13 studies (44.8%) provided descriptions that captured at least three of the eight IROs. There was limited reporting of acceptability, feasibility, fidelity, cost and sustainability. CONCLUSION EBIs are effective for SCD management in LMICs; however, measurement of IROs is scarce. Future research should focus on penetration of EBIs to inform evidence-based practice and sustainability in the context of LMICs. CLINICAL TRIAL REGISTRATION This review is registered in PROSPERO #CRD42020167289.
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Affiliation(s)
- Joyce Gyamfi
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Temitope Ojo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, United States of America
| | - Sabrina Epou
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Amy Diawara
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Lotanna Dike
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Deborah Adenikinju
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Scholastica Enechukwu
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Dorice Vieira
- New York University Health Sciences Library, New York, New York, United States of America
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Gbenga Ogedegbe
- Department of Population Health, New York University Medical Center, New York, New York, United States of America
| | - Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, United States of America
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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Caregivers’ level of knowledge and home- based practices for prevention of Sickle cell disease related complications among children attending Mnazi mmoja hospital in Zanzibar. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Suliman MA, Hassan AM, Kaddam LA. Association between renal function parameters, clinical severity score and mortality risk among adult Sudanese sickle anemia patients. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:434-439. [PMID: 33489452 PMCID: PMC7811912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sickle Cell Anemia (SCA) is an autosomal recessive haemoglobinopathy with high morbidity and mortality. Global survival of sickle patients is increased due to advances in management; and subsequently, prevalence of chronic complications including renal manifestations also increased. Therefore, early detection and management of these complications is mandatory. This study aimed to investigate the estimated Glomerular Filtration Rate (eGFR), proteinuria and serum uric acid as markers of renal involvement in Sudanese sickle adults and association between these parameters and clinical severity score of sickle cell disease. METHODS Cross-sectional hospital-based study included thirty-two adult Sudanese patients diagnosed with SCA and twenty-three as controls. Written informed consent was obtained from each participant. Blood and urine samples were collected. Severity score was calculated using Bios online calculator and eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula without adjustment for ethnicity. Associations between the severity score and renal parameters were tested using unpaired T test and Mann Whitney test for normally and non-normally distributed data and correlations between variables were tested using SPSS version 23. RESULTS Protein/Creatinine Ratio (PCR) was significantly higher (p-value < 0.001) in sickle cell anaemia group compared to controls. Hyper-filtration and Hyperuricemia were manifested in 75% and 6.3% of SCA group respectively. There was no association between the severity score and renal manifestations in the SCA group. CONCLUSIONS Hyper-filtration and proteinuria were the most prevalent renal manifestations in SCA group. Further studies are recommended to determine the predictors of renal complications and ensure early management of such complications.
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Affiliation(s)
- Mohamed Ao Suliman
- Department of Physiology, Faculty of Medicine, Al Neelain University Khartoum, Sudan
| | - Alnazeer Ma Hassan
- Department of Physiology, Faculty of Medicine, Al Neelain University Khartoum, Sudan
| | - Lamis A Kaddam
- Department of Physiology, Faculty of Medicine, Al Neelain University Khartoum, Sudan
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Salama K, Rady R, Hashem RH, El-Ghamrawy M. Transcranial Doppler Velocities among Sickle Cell Disease Patients in Steady State. Hemoglobin 2020; 44:418-422. [PMID: 33164583 DOI: 10.1080/03630269.2020.1843483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Transcranial Doppler (TCD) screening is an established tool to identify children with sickle cell disease at high risk of stroke. Our objective was to study TCD velocities among sickle cell disease patients while in a steady state. This cross-sectional study included 78 steady state sickle cell disease patients [31 Hb SS (βS/βS) (sickle cell anemia), 47 Hb S/β-thalassemia (HBB: c.20A>T/β-thal)], attending the Pediatric Hematology Clinic at Cairo University Children's Hospital, Cairo, Egypt. All patients underwent TCD velocity assessment as per the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. In our cohort, TCD velocities were comparable among Hb S/β-thal vs. SS patients. Hemolysis indicators correlated significantly to TCD velocities in Hb S/β-thal patients; positive correlation was found between total bilirubin level and right middle cerebral artery (MCA) and right distal internal carotid artery (dICA) TCD velocities (r = 0.428, p = 0.00, r = 0.360, p = 0.01), respectively as well as between reticulocyte count and right MCA, right dICA and right anterior cerebral artery (ACA) TCD velocities (r = 0.424, p = 0.01), (r = 0.40, p = 0.00), (r = 0.303, p = 0.04), respectively. On the other hand, statistically significant negative correlations were found between hemoglobin (Hb) level and right ACA, right dICA TCD velocities (r = -0.290, p = 0.05), (r = -0.324, p = 0.03). Although Hb F is considered an ameliorating factor for disease severity; hemolysis stands as an indicator of risk for TCD velocity elevation, and in turn, risk for stroke among sickle cell disease patients.
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Affiliation(s)
- Khaled Salama
- Department of Pediatrics, Pediatric Hematology & Bone Marrow Transplantation (BMT) Unit, Cairo University, Cairo, Egypt
| | - Rasha Rady
- Department of Pediatrics, Pediatric Hematology & Bone Marrow Transplantation (BMT) Unit, Cairo University, Cairo, Egypt
| | - Rania H Hashem
- Department of Diagnostic and Interventional Radiology, Cairo University, Cairo, Egypt
| | - Mona El-Ghamrawy
- Department of Pediatrics, Pediatric Hematology & Bone Marrow Transplantation (BMT) Unit, Cairo University, Cairo, Egypt
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Appiah S, Korsah KA, AmpongAdjei C, Appiah OE. Genetic counselling in sickle cell disease: views of single young adults in Ghana. J Community Genet 2020; 11:485-493. [PMID: 32613518 PMCID: PMC7475149 DOI: 10.1007/s12687-020-00474-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/21/2020] [Indexed: 11/28/2022] Open
Abstract
Sickle cell disease is a chronic inherited blood disorder affecting many people globally as well as in Sub-Saharan Africa. In Ghana, the disease has a prevalence of 2% with carrier rate of 20-25% among the populace. Genetic counselling is a cost-effective strategy in reducing the burden of this disorder. However, little is known about the relevance of this intervention particularly among young adults in their reproductive age. The purpose of this is to explore the views of single young adults about genetic counselling in the Accra metropolis, Ghana. An exploratory descriptive qualitative designed was used. Thirty-two (32) young adults between the ages of 18 and 28 years were purposively selected from a private university in Ghana. Four focus group discussions and twelve in-depth interviews were conducted. Data was analysed using content analysis technique. The results of the study revealed that young adults had knowledge about SCD and due to that showed positive perceptions towards genetic counselling in SCD. However, they were unaware of genetic counselling facilities in the country. They expressed willingness to accept genetic counselling related to SCD whether for a fee or for free. It was concluded that establishment of a number of genetic counselling centres is very crucial in the metropolis.
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Affiliation(s)
- Stella Appiah
- Department of Nursing, Valley View University, Box AF 595, Adentan, Accra, Ghana
| | - Kwadwo Ameyaw Korsah
- Department of Adult Health, School of Nursing, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Charles AmpongAdjei
- Department of Community Health Nursing, School of Nursing, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Osei Evans Appiah
- Ghana Health Service, Ga-West Municipal Hospital, Amasaman, Accra, Ghana
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Kinger NP, Moreno CC, Miller FH, Mittal PK. Abdominal Manifestations of Sickle Cell Disease. Curr Probl Diagn Radiol 2020; 50:241-251. [PMID: 32564896 DOI: 10.1067/j.cpradiol.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/24/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022]
Abstract
Sickle cell disease is a debilitating hematologic process that affects the entire body. Disease manifestations in the abdomen most commonly result from vaso-occlusion, hemolysis, or infection due to functional asplenia. Organ specific manifestations include those involving the liver (eg, hepatopathy, iron deposition), gallbladder (eg, stone formation), spleen (eg, infarction, abscess formation, sequestration), kidneys (eg, papillary necrosis, infarction), pancreas (eg, pancreatitis), gastrointestinal tract (eg, infarction), reproductive organs (eg, priapism, testicular atrophy), bone (eg, marrow changes, avascular necrosis), vasculature (eg, vasculopathy), and lung bases (eg, acute chest syndrome, infarction). Imaging provides an important clinical tool for evaluation of acute and chronic disease manifestations and complications. In summary, there are multifold abdominal manifestations of sickle cell disease. Recognition of these sequela helps guide management and improves outcomes. The purpose of this article is to review abdominal manifestations of sickle cell disease and discuss common and rare complications of the disease within the abdomen.
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Affiliation(s)
- Nikhar P Kinger
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pardeep K Mittal
- Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA
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Hasan MN, Fraiwan A, An R, Alapan Y, Ung R, Akkus A, Xu JZ, Rezac AJ, Kocmich NJ, Creary MS, Oginni T, Olanipekun GM, Hassan-Hanga F, Jibir BW, Gambo S, Verma AK, Bharti PK, Riolueang S, Ngimhung T, Suksangpleng T, Thota P, Werner G, Shanmugam R, Das A, Viprakasit V, Piccone CM, Little JA, Obaro SK, Gurkan UA. Paper-based microchip electrophoresis for point-of-care hemoglobin testing. Analyst 2020; 145:2525-2542. [PMID: 32123889 DOI: 10.1039/c9an02250c] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nearly 7% of the world's population live with a hemoglobin variant. Hemoglobins S, C, and E are the most common and significant hemoglobin variants worldwide. Sickle cell disease, caused by hemoglobin S, is highly prevalent in sub-Saharan Africa and in tribal populations of Central India. Hemoglobin C is common in West Africa, and hemoglobin E is common in Southeast Asia. Screening for significant hemoglobin disorders is not currently feasible in many low-income countries with the high disease burden. Lack of early diagnosis leads to preventable high morbidity and mortality in children born with hemoglobin variants in low-resource settings. Here, we describe HemeChip, the first miniaturized, paper-based, microchip electrophoresis platform for identifying the most common hemoglobin variants easily and affordably at the point-of-care in low-resource settings. HemeChip test works with a drop of blood. HemeChip system guides the user step-by-step through the test procedure with animated on-screen instructions. Hemoglobin identification and quantification is automatically performed, and hemoglobin types and percentages are displayed in an easily understandable, objective way. We show the feasibility and high accuracy of HemeChip via testing 768 subjects by clinical sites in the United States, Central India, sub-Saharan Africa, and Southeast Asia. Validation studies include hemoglobin E testing in Bangkok, Thailand, and hemoglobin S testing in Chhattisgarh, India, and in Kano, Nigeria, where the sickle cell disease burden is the highest in the world. Tests were performed by local users, including healthcare workers and clinical laboratory personnel. Study design, methods, and results are presented according to the Standards for Reporting Diagnostic Accuracy (STARD). HemeChip correctly identified all subjects with hemoglobin S, C, and E variants with 100% sensitivity, and displayed an overall diagnostic accuracy of 98.4% in comparison to reference standard methods. HemeChip is a versatile, mass-producible microchip electrophoresis platform that addresses a major unmet need of decentralized hemoglobin analysis in resource-limited settings.
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Affiliation(s)
- Muhammad Noman Hasan
- Case Biomanufacturing and Microfabrication Laboratory, Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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47
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Analgesic management of uncomplicated acute sickle‐cell pain crisis in pediatrics: a systematic review and meta‐analysis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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48
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Saramba MI, Shakya S, Zhao D. Analgesic management of uncomplicated acute sickle-cell pain crisis in pediatrics: a systematic review and meta-analysis. J Pediatr (Rio J) 2020; 96:142-158. [PMID: 31351033 PMCID: PMC9432155 DOI: 10.1016/j.jped.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/18/2019] [Accepted: 05/08/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To capture evidence of the efficacy and safety of pharmacological analgesia for uncomplicated acute sickle-cell pain in pediatric patients compared to placebo. SOURCES OF DATA Searches for key evidence were performed from March 1 to 31, 2018, for randomized controlled trials of pharmacological analgesia compared to placebo for uncomplicated acute sickle-cell pain in a pediatric sample. The authors searched ten scientific databases including, among others, PubMed, MEDLINE, Embase, and Clinicaltrials.gov for this systematic review and meta-analysis. SUMMARY OF THE FINDINGS Four trials (n=227) were selected by the inclusion criteria (intranasal fentanyl, intravenous magnesium, arginine, and inhaled nitric oxide). The quality of evidence ranged from low to moderate for each outcome. Meta-analysis of changes in the ladder of pain score (p=0.72), length-of-stay in hospital (p=0.65), and amount of narcotics used during the study (p=0.10) showed non-statistically significant differences and a lack of amelioration provided by pharmaceutical analgesics in treatment group. The adverse events reported that more participants in the intervention arm underwent pain, with statistically significant differences at the drug delivery site in studies using intranasal fentanyl and intravenous magnesium (p=0.03). CONCLUSIONS Pharmacological analgesia appears to be uncertain in improving the intensity and providing relief of acute pain crisis in pediatric patients with sickle-cell anemia. With respect to clinical advantage, no decisive deduction about the clinical efficacy may be made regarding these medications in acute sickle-cell pain management in the pediatric age group.
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Affiliation(s)
- Manou Irmina Saramba
- Zhongnan Hospital of Wuhan University, Children's Digital and Health Data Research Center, Department of Pediatrics, Wuhan, China
| | - Sandeep Shakya
- Zhongnan Hospital of Wuhan University, Children's Digital and Health Data Research Center, Department of Pediatrics, Wuhan, China
| | - Dongchi Zhao
- Zhongnan Hospital of Wuhan University, Children's Digital and Health Data Research Center, Department of Pediatrics, Wuhan, China.
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49
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Erhabor O, Ogar K, Erhabor T, Dangana A. Some haematological parameters, copper and selenium level among children of African descent with sickle cell disease in Specialist Hospital Sokoto, Nigeria. Hum Antibodies 2020; 27:143-154. [PMID: 30909199 DOI: 10.3233/hab-180360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sickle cell disease is a genetic disorder of haemoglobin causing myriad of pathology including anaemia. OBJECTIVES The aim of this study was to evaluate some haematological parameters and trace elements of total of forty-five (45) children with Sickle cell disease attending Specialist Hospital Sokoto. METHOD Twenty-five (25) apparently healthy children which were assessed as controls. The haematological parameters were determined using automated method and trace elements (copper and selenium) were determined using colorimetric and atomic absorption spectrophotometry method respectively. RESULTS The Mean WBC and PLT was significantly higher among sickle cell disease subjects when compared to controls individuals (p< 0.05). The Mean RBC, HCT, HGB, MCV, MCH and MCHC was significantly lower among Sickle cell disease patients when compared to controls (p< 0.05). The Mean Copper and Selenium value was significantly lower (40.4 ± 1.44 μg/dl and 54.6 ± 1.60 ng/ml) among Sickle cell disease subjects compared to controls (75.6 ± 1.30 μg/dl and 86.3 ± 2.30 ng/ml) (p< 0.05). The WBC, HGB, HGT and Copper values of Sickle cell disease subjects shows a weak positive put non-statistically significant correlation with age (p> 0.05). The RBC, MCV, MCH, MCHC, PLT, and Selenium values of sickle cell disease patients shows a negative non-statistically significant correlation indicating that the selenium level decreases as the age increases (p< 0.05). CONCLUSION This study shows that the WBC and platelet count was significantly higher among sickle cell disease subjects compared to controls. The RBC, HCT, HGB, MCV, MCH and MCHC were significantly lower among sickle cell disease patients compared to controls. The serum copper and selenium levels were significantly lower among sickle cell subjects compared to controls. We recommend that trace elements (copper and selenium) and haematological parameters be monitored routinely among sickle cell disease children to optimize the care offered to these individuals.
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Affiliation(s)
- Osaro Erhabor
- Department of Haematology, School of Medical Laboratory Science, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Kevin Ogar
- Department of Haematology, School of Medical Laboratory Science, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Tosan Erhabor
- Medical Laboratory Science Council of Nigeria, Nigeria
| | - Amos Dangana
- Department of Haematology, University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
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50
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Ito MT, da Silva Costa SM, Baptista LC, Carvalho-Siqueira GQ, Albuquerque DM, Rios VM, Ospina-Prieto S, Saez RC, Vieira KP, Cendes F, Ozelo MC, Saad STO, Costa FF, Melo MB. Angiogenesis-Related Genes in Endothelial Progenitor Cells May Be Involved in Sickle Cell Stroke. J Am Heart Assoc 2020; 9:e014143. [PMID: 32009522 PMCID: PMC7033889 DOI: 10.1161/jaha.119.014143] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The clinical aspects of sickle cell anemia (SCA) are heterogeneous, and different patients may present significantly different clinical evolutions. Almost all organs can be affected, particularly the central nervous system. Transient ischemic events, infarcts, and cerebral hemorrhage can be observed and affect ≈25% of the patients with SCA. Differences in the expression of molecules produced by endothelial cells may be associated with the clinical heterogeneity of patients affected by vascular diseases. In this study, we investigated the differential expression of genes involved in endothelial cell biology in SCA patients with and without stroke. Methods and Results Endothelial progenitor cells from 4 SCA patients with stroke and 6 SCA patients without stroke were evaluated through the polymerase chain reaction array technique. The analysis of gene expression profiling identified 29 differentially expressed genes. Eleven of these genes were upregulated, and most were associated with angiogenesis (55%), inflammatory response (18%), and coagulation (18%) pathways. Downregulated expression was observed in 18 genes, with the majority associated with angiogenesis (28%), apoptosis (28%), and cell adhesion (22%) pathways. Remarkable overexpression of the MMP1 (matrix metalloproteinase 1) gene in the endothelial progenitor cells of all SCA patients with stroke (fold change: 204.64; P=0.0004) was observed. Conclusions Our results strongly suggest that angiogenesis is an important process in sickle cell stroke, and differences in the gene expression profile of endothelial cell biology, especially MMP1, may be related to stroke in SCA patients.
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Affiliation(s)
- Mirta T Ito
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Sueli M da Silva Costa
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Letícia C Baptista
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | | | | | - Vinicius M Rios
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | | | - Roberta C Saez
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Karla P Vieira
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory Department of Neurology University of Campinas, UNICAMP Campinas São Paulo Brazil
| | - Margareth C Ozelo
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Sara Teresinha O Saad
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Mônica B Melo
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
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