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Bills SE, Schatz J, Varanasi S, Johnston JD, Gillooly E. Comorbid ADHD and Pediatric Sickle Cell Disease: Prevalence and Risk Factors. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10027-3. [PMID: 38982025 DOI: 10.1007/s10880-024-10027-3] [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] [Accepted: 06/02/2024] [Indexed: 07/11/2024]
Abstract
Sickle cell disease (SCD) is a genetic blood condition that places youth at increased risk for deficits in complex attention suggestive of increased risk for Attention-Deficit/Hyperactivity Disorder (ADHD). We used systematic screening to assess the prevalence of ADHD in a clinic-based sample of youth with SCD and explored factors related to ADHD. Caregivers of 107 children with SCD (ages 7-11 years) completed routine psychosocial screening which included inattentive symptoms of ADHD. Follow-up diagnostic procedures were completed for patients with elevated inattentive symptoms to assess for ADHD diagnoses. Biomedical and social-environmental variables were examined from the screening and medical records. Twenty-six percent of patients showed elevated inattentive symptoms with 13% meeting diagnostic criteria for ADHD diagnoses. Most children (75%) who met criteria for ADHD had not been previously diagnosed. Disease severity did not predict inattentive symptoms or ADHD diagnoses, though a measure of chronic inflammation was associated with ADHD. Family functioning was related to elevated inattentive symptoms but not ADHD diagnoses. Children with SCD show relatively high rates of ADHD with many cases not detected through routine care. Screening for ADHD as part of hematology care may be a feasible strategy to improve identification and access to intervention.
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Affiliation(s)
- Sarah E Bills
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA.
| | - Jeffrey Schatz
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA
| | - Sreya Varanasi
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA
| | - Julia D Johnston
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA
| | - Elizabeth Gillooly
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA
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2
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Garelnabi M, Parinandi NL. Role of Traditional Stroke Risk Factors Aiding in Prediction of Infarcts in Adult Patients With Sickle Cell Disease. J Am Heart Assoc 2024; 13:e034798. [PMID: 38842295 PMCID: PMC11255737 DOI: 10.1161/jaha.124.034798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Mahdi Garelnabi
- Department of Biomedical and Nutritional Sciences, UMass Lowell Center for Population HealthUniversity of MassachusettsLowellMAUSA
| | - Narasimham L. Parinandi
- Division of Pulmonary, Critical Care and Sleep MedicineDavis Heart and Lung Research Institute, The Ohio State University College of MedicineColumbusOHUSA
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3
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Oni MO, Brito M, Rotman C, Archer NM. Genetic Modifiers of Stroke in Patients with Sickle Cell Disease-A Scoping Review. Int J Mol Sci 2024; 25:6317. [PMID: 38928024 PMCID: PMC11203960 DOI: 10.3390/ijms25126317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Sickle cell disease (SCD) clinically manifests itself with a myriad of complications. Stroke, both ischemic and hemorrhagic, as well as silent white matter changes, occurs at a relatively high prevalence. Understanding why and in whom stroke is most likely to occur is critical to the effective prevention and treatment of individuals with SCD. Genetic studies, including genome- and exome-wide association studies (GWAS and EWAS), have found several key modifiers associated with increased stroke/stroke risk in SCD via mechanisms including Hemoglobin F (HbF) modulation, inflammation, cellular adhesion, endothelial disruption, and hemolysis. We present a review on the modifiers that have most clearly demonstrated an association to date. More studies are needed to validate other potential polymorphisms and identify new ones. Incorporating gene-focused screenings in clinical care could provide avenues for more targeted, more effective, and less toxic prevention of stroke in this population. The data from this review will be used to inform the initial GWAS performed by the International Hemoglobinopathy Research Network (INHERENT) consortium.
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Affiliation(s)
- Morohuntodun O. Oni
- Pediatric Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02115, USA;
| | - Miguel Brito
- H&TRC—Health & Technology Research Center, ESTeSL—Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-092 Lisbon, Portugal;
| | - Chloe Rotman
- Medical Library, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Natasha M. Archer
- Pediatric Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02115, USA;
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4
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Jacobs JW, Guarente J, Karp JK, Grossman BJ, Ziman AF, McGonigle AM, Binns TC, Gish TJ, Gorham JD, Park YA, Perez-Alvarez I, Burner JD, Mei ZW, Ward DC, Woo JS, Booth GS, Adkins BD, Webb CB, Yamada C, Lee GM, Abels E, Marques MB, Allen ES, Fasano RM, Crowe EP, Tobian AA, Tormey CA, Bloch EM. Factitious disorder presenting as sickle cell disease: a case report. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100761. [PMID: 38745885 PMCID: PMC11090869 DOI: 10.1016/j.lana.2024.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Jeremy W. Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Juliana Guarente
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Julie K. Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brenda J. Grossman
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alyssa F. Ziman
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrea M. McGonigle
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas C. Binns
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tappy J. Gish
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - James D. Gorham
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Yara A. Park
- Department of Pathology and Laboratory Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | - Ingrid Perez-Alvarez
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James D. Burner
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zhen W. Mei
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dawn C. Ward
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer S. Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Garrett S. Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian D. Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher B. Webb
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chisa Yamada
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Grace M. Lee
- Division of Hematology, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Abels
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | - Marisa B. Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth S. Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Ross M. Fasano
- Center for Transfusion Medicine and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, and Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Elizabeth P. Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Moshi BN, Philipo EG, Kileo NF, Matobo J, Yondu E, Ikunda D, Kandonga D, Luhulla KM, Kilonzi M. Prevalence of Stroke in Individuals with Sickle Cell Disease Pre- and during Hydroxyurea Uses: A Descriptive Cross-Sectional Study in Tanzania. Adv Hematol 2024; 2024:7950925. [PMID: 38533292 PMCID: PMC10965277 DOI: 10.1155/2024/7950925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
Sickle cell disease (SCD) is an inherited blood disorder that leads to a variety of complications, including stroke. The use of hydroxyurea (HU) is reported to lessen the frequency and burden of stroke in SCD patients. However, less is known about the prevalence of stroke in SCD patients pre- and during the use of HU in sub-Saharan African (SSA) countries. Therefore, the study assessed stroke prevalence before and during uses of hydroxyurea among SCD patients in Tanzania. A hospital-based descriptive cross-sectional study was conducted at the sickle cell clinics in Dar es Salaam, Tanzania, from April 2023 to May 2023. A total of 228 participants were recruited, and data on demographic and clinical characteristics, HU use, and history of stroke were collected using a checklist from the respective patients' medical records and verbal communication with the patients or caregivers. Data analysis was done using SPSS software version 25, and findings are summarized using frequency and percentages. Out of 228 enrolled SCD patients, 124 (54.4%) were females, 109 (47.8%) were aged between 6 and 12 years, 226 (99.1%) were not married, 181 (79.4%) had primary education, and 209 (95%) were unemployed. The prevalence of stroke pre-HU use was 28 (12.3%) and 6 (2.6%) after starting using HU. Out of 6 with stroke after starting using HU, 3 (50%) had a history of stroke pre-HU uses. The study showed that the prevalence of stroke among SCD patients is significantly reduced after HU use. The findings suggest the need for stakeholders to implement measures to ensure eligible SCD patients are kept on HU.
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Affiliation(s)
- Belinda Nestory Moshi
- School of Pharmacy, The Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Erick G. Philipo
- School of Pharmacy, The Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Nancy F. Kileo
- School of Diagnostic Medicine, The Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Joseph Matobo
- Department of Pediatrics, The Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania
| | - Emili Yondu
- School of Pharmacy, The Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Dionis Ikunda
- School of Medicine and Dentistry, University of Dodoma, P. O. Box 395, Dodoma, Tanzania
| | - Daniel Kandonga
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Koga M. Luhulla
- Department of Pediatrics, The Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- School of Pharmacy, The Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
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Nawaiseh MB, Yassin AM, Al-Sabbagh MQ, AlNawaiseh A, Zureigat H, Aljbour AlMajali D, Haddadin RR, El-Ghanem M, Abu-Rub M. Abnormal Neurologic Findings in Patients With Sickle Cell Disease Without a History of Major Neurologic Events. Neurol Clin Pract 2024; 14:e200215. [PMID: 38173541 PMCID: PMC10759091 DOI: 10.1212/cpj.0000000000200215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/12/2023] [Indexed: 01/05/2024]
Abstract
Background and Objectives Patients with sickle cell disease (SCD) are prone to symptomatic neurologic complications. Previous studies reported accrual of neural injury starting at early age, even without having symptomatic neurologic events. The aim of this study was to assess the prevalence and risk factors of abnormal neurologic findings in patients with SCD with no history of major symptomatic neurologic events. Methods Our study extracted patients diagnosed with SCD from the Cooperative Study of Sickle Cell Disease. Patients who underwent a neurologic evaluation were included in our analysis. Patients with previous documented major symptomatic neurologic events were excluded. We compared patients with SCD with abnormal neurologic findings with those without in terms of clinical and laboratory parameters using multivariate binary logistic regression. Results A total of 3,573 patients with SCD were included (median age = 11 [IQR = 19] years, male = 1719 [48.1%]). 519 (14.5%) patients had at least one abnormal neurologic finding. The most common findings in descending order were abnormal reflexes, gait abnormalities, cerebellar dysfunction, language deficits, nystagmus, abnormal muscle tone and strength, Romberg sign, Horner syndrome, and intellectual impairment. History of eye disease (odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.63-4.68) and history of osteomyelitis (OR = 2.55, 95% CI 1.34-4.84) were the strongest predictors of abnormal neurologic findings, followed by smoking (OR = 1.59, 95% CI 1.08-2.33), aseptic necrosis (OR = 1.57, 95% CI 1.06-2.33), hand-foot syndrome (OR = 1.48, 95% CI 1.04-2.12), and male sex (OR = 1.42, 95% CI 1.01-2.02). Discussion Neurologic deficits are relatively common in patients with SCD, even without documented major neurologic insults. They range from peripheral and ophthalmic deficits to central and cognitive disabilities. Patients with SCD should have early regular neurologic evaluations and risk factor modification, particularly actively promoting smoking cessation.
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Affiliation(s)
- Mohammed B Nawaiseh
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Ahmed M Yassin
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Mohammed Q Al-Sabbagh
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Ahmad AlNawaiseh
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Hadil Zureigat
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Dina Aljbour AlMajali
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Rund R Haddadin
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Mohammad El-Ghanem
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Mohammad Abu-Rub
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
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de Oliveira Taques W, Bett GC, de Moraes BLB, Medeiros I, Fontes CJF, Godinho de Oliveira R. Factors Associated with Overt Stroke in Children and Adolescents with Sickle Cell Disease: A Retrospective Cohort Study. Hemoglobin 2024; 48:39-46. [PMID: 38263710 DOI: 10.1080/03630269.2023.2301490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
Sickle cell disease (SCD) is associated with a high occurrence of complications due to vaso-occlusive phenomenon such as stroke. This retrospective cohort study aimed to examine the clinical and laboratory characteristics of 120 children and adolescents with SCD and analyze the factors associated with overt stroke incidence. All relevant data were obtained from patient medical records. Survival analysis was used to compare the demographic, clinical, and laboratory characteristics between patients with and those without overt stroke. The patients were 52.5% female with a mean (SD) age of 11.2 (4.3) years. The incidence of overt stroke in this cohort was nine out of 956.7 patient-years, resulting in an incidence density of 0.94 cases/100 patient-years. Reports of greater than or equal to two previous attacks of dactylitis and greater than or equal to three episodes of acute chest syndrome (ACS)/pneumonia were associated with overt stroke and an increase in reticulocyte count and red blood cell distribution width (RDW). In conclusion, a history of a high number of dactylitis, ACS/pneumonia, increased RDW, and reticulocytosis was associated with overt stroke occurrence in children and adolescents with SCD. Future studies with a higher stroke incidence in the evaluated sample are necessary to confirm this hypothesis.
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Affiliation(s)
- Wolney de Oliveira Taques
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
- Hematology Outpatient Clinic of MT-Hemocentro, State Health Department of MT - Mato Grosso, Cuiabá, Brazil
| | - Gabriele Curvo Bett
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | | | - Iasmin Medeiros
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | - Cor Jesus Fernandes Fontes
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | - Ruberlei Godinho de Oliveira
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
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8
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Joseph L, Driessen M. A comprehensive view of pregnancy in patients with sickle cell disease in high-income countries: the need for robust data and further decline in morbidity and mortality. Lancet Haematol 2024; 11:e75-e84. [PMID: 38135375 DOI: 10.1016/s2352-3026(23)00310-1] [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: 02/22/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023]
Abstract
Sickle cell disease is a major public health concern due to its prevalence and associated morbidities. In high-income countries, diagnosis and treatment advancements have extended patient's lives and enabled women to embrace motherhood. Although the provision of care in specialist centres has reduced maternal-fetal complication rates, the mortality rate among pregnant women with sickle cell disease remains disproportionately high. Complications arise from vaso-occlusive events, worsening organ damage, thrombotic risks, infections, and pregnancy-related issues, such as pre-eclampsia, premature birth, small-for-gestational-age, and pregnancy loss. Effective management during pregnancy includes preconception planning, genetic counselling, education, and collaborative care. There is no consensus on the overall approach to managing pregnant women with sickle cell disease; however, fostering a collaborative relationship between health-care professionals and researchers is crucial for advancing the understanding and management of this illness. The disparities in health-care outcomes associated with ethnicity and economic insecurity affect patients with sickle cell disease but have not been examined extensively. Hence, health-care personnel need sufficient training to address these issues alongside broader societal efforts to confront racism and discrimination. Comprehensive national and global action plans are required to address the multifaceted challenges of sickle cell disease.
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Affiliation(s)
- Laure Joseph
- Biotherapy Department, French National Sickle Cell Referral Centre, Biotherapy Clinical Investigation Centre, Hôpital Necker-Enfant Malades, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Marine Driessen
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfant Malades, Assistance-Publique Hôpitaux de Paris, Paris, France
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9
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Jacobs JW, Adkins BD, Stephens LD, Woo JS, Booth GS. Risks and benefits of cannabis as a pain control modality in patients with sickle cell disease. Clin Hematol Int 2023; 5:47-50. [PMID: 38817956 PMCID: PMC10730994 DOI: 10.46989/001c.90837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/17/2023] [Indexed: 06/01/2024] Open
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine Yale School of Medicine, New Haven, CT, USA
| | - Brian D Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laura D Stephens
- Department of Pathology University of California, San Diego, La Jolla, CA, USA
| | - Jennifer S Woo
- Department of Pathology City Of Hope National Medical Center, Irvine, CA, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology, & Immunology Vanderbilt University Medical Center, Nashville, TN, USA
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10
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Zayed AM, Al-Muhaimeed S, Al-Otaibi T, Ali EM, Saleh R, Ancheta SJ, Al-Harbi F, Waheed KB, Albahli Y, Alghamdi H. Moyamoya Syndrome in Children With Sickle Cell Disease in Saudi Arabia: A Single-Center Experience. Cureus 2023; 15:e49039. [PMID: 38024048 PMCID: PMC10657488 DOI: 10.7759/cureus.49039] [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: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Sickle cell disease (SCD) is relatively common in Saudi Arabia. Its neurologic complications such as stroke and Moyamoya syndrome (MMS) can be severe and devastating. Such complications can be minimized by modern investigative tools such as transcranial Doppler (TCD) ultrasound, which is unavailable in many high-risk places. Our aim is to investigate the prevalence and characteristics of these complications in children with SCD in our center where TCD is not available. Methods We conducted a retrospective record review of children with SCD admitted to the pediatric ward and visited the pediatric hematology outpatient clinic of King Fahad Military Medical Complex, Dhahran, Saudi Arabia, from January 2010 to December 2021. The target population was children aged six months to 14 years with SCD and a history of stroke or transient ischemic attacks (TIAs). Their magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) of the brain radiographic features were reviewed. A descriptive analysis was used to summarize the demographic characteristics and clinical features of patients with and without MMS. Results Twenty-six children (out of 385 with sickle cell anemia, originating mainly from the southwestern and eastern provinces of Saudi Arabia) experienced an overt stroke with an overall prevalence of 6.7%. All patients with stroke were originally from the Southwestern province. Their genotype was SS, and the median age at the onset of the first stroke was six years (IQR: 5.5). The main presenting symptoms were seizures (57.7%), motor weakness (42.3%), headache (15.3%), cranial nerve palsies (11.5%), cognitive deficit (7.6%), and dysphasia (3.8%). The majority of strokes were ischemic (92.3%). MMS was detected in 61.5% and was seen at the onset of the first stroke in all patients with this MRA abnormality. Seven children with moyamoya (43.8%) had recurrent strokes. Conclusion In this study, the prevalence of overt stroke is 9% in children with SCD originating from the southwestern region of Saudi Arabia (26/286), and 61.5% of them (16/26) had MMS. It is absent in the children of Eastern origin (99 children). In places lacking TCD facilities, further studies are required to determine if MRA brain screenings of children with SCD may detect MMS before the onset of stroke and help start protective therapy.
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Affiliation(s)
- Abdalla M Zayed
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Turki Al-Otaibi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Rashid Saleh
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Fahad Al-Harbi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Yasir Albahli
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | - Hamid Alghamdi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
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11
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d'Humières T, Saba J, Savale L, Dupuy M, Boyer L, Guillet H, Alassaad L, de Luna G, Iles S, Pham Hung d'Alexandry d'Orengiani AL, Zaouali Y, Boukour N, Pelinski Y, Messonnier L, Audureau E, Derbel H, Habibi A, Lellouche N, Derumeaux G, Bartolucci P. Determinants of ventricular arrhythmias in sickle cell anemia: toward better prevention of sudden cardiac death. Blood 2023; 142:409-420. [PMID: 37216685 DOI: 10.1182/blood.2022019571] [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: 12/27/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
Sudden death is 1 of the leading causes of death in adults with sickle cell anemia (SCA) but its etiology remains mostly unknown. Ventricular arrhythmia (VA) carries an increased risk of sudden death; however, its prevalence and determinants in SCA are poorly studied. This study aimed to identify the prevalence and predictors of VA in patients with SCA. From 2019 to 2022, 100 patients with SCA were referred to the physiology department to specifically analyze cardiac function and prospectively included in the DREPACOEUR registry. They underwent a 24-hour electrocardiogram monitoring (24h-Holter), transthoracic echocardiography, and laboratory tests on the same day. The primary end point was the occurrence of VA, defined as sustained or nonsustained ventricular tachycardia (VT), >500 premature ventricular contractions (PVCs) on 24h-Holter, or a recent history of VT ablation. The mean patient age was 46 ± 13 years, and 48% of the patients were male. Overall, VA was observed in 22 (22%) patients. Male sex (81% vs 34%; P = .02), impaired global longitudinal strain (GLS): -16% ± 1.9% vs -18.3% ± 2.7%; P = .02), and decreased platelet count (226 ± 96 giga per liter [G/L] vs 316 ± 130 G/L) were independently associated with VA. GLS correlated with PVC load every 24 hours (r = 0.39; P < .001) and a cutoff of -17.5% could predict VA with a sensitivity of 82% and a specificity of 63%. VAs are common in patients with SCA, especially in men. This pilot study uncovered GLS as a valuable parameter for improving rhythmic risk stratification.
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MESH Headings
- Adult
- Humans
- Male
- Middle Aged
- Female
- Pilot Projects
- Arrhythmias, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Anemia, Sickle Cell/complications
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Affiliation(s)
- Thomas d'Humières
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Joseph Saba
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension, Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marie Dupuy
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Laurent Boyer
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Henri Guillet
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Lara Alassaad
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Gonzalo de Luna
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Sihem Iles
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Anne L Pham Hung d'Alexandry d'Orengiani
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Yosr Zaouali
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Nouhaila Boukour
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Yanis Pelinski
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Laurent Messonnier
- Inter-university Laboratory of Human Movement Sciences EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Etienne Audureau
- Department of Biostatistics, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, CEpiA IMRB U955, FHU SENEC, Université Paris Est, Créteil, France
| | - Haytham Derbel
- Department of Radiology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Est, Créteil, France
| | - Anoosha Habibi
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Est, Créteil, France
| | - Geneviève Derumeaux
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Pablo Bartolucci
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
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12
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Sijilmassi O, López Alonso JM, Del Río Sevilla A, Barrio Asensio MDC. Multispectral Imaging Method for Rapid Identification and Analysis of Paraffin-Embedded Pathological Tissues. J Digit Imaging 2023; 36:1663-1674. [PMID: 37072579 PMCID: PMC10406798 DOI: 10.1007/s10278-023-00826-9] [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: 10/21/2021] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
The study of the interaction between light and biological tissue is of great help in the identification of diseases as well as structural alterations in tissues. In the present study, we have developed a tissue diagnostic technique by using multispectral imaging in the visible spectrum combined with principal component analysis (PCA). We used information from the propagation of light through paraffin-embedded tissues to assess differences in the eye tissues of control mouse embryos compared to mouse embryos whose mothers were deprived of folic acid (FA), a crucial vitamin necessary for the growth and development of the fetus. After acquiring the endmembers from the multispectral images, spectral unmixing was used to identify the abundances of those endmembers in each pixel. For each acquired image, the final analysis was performed by performing a pixel-by-pixel and wavelength-by-wavelength absorbance calculation. Non-negative least squares (NNLS) were used in this research. The abundance maps obtained for the first endmember revealed vascular alterations (vitreous and choroid) in the embryos with maternal FA deficiency. However, the abundance maps obtained for the third endmember showed alterations in the texture of some tissues such as the lens and retina. Results indicated that multispectral imaging applied to paraffin-embedded tissues enhanced tissue visualization. Using this method, first, it can be seen tissue damage location and then decide what kind of biological techniques to apply.
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Affiliation(s)
- Ouafa Sijilmassi
- Faculty of Optics and Optometry, Anatomy and Embryology Department, Universidad Complutense de Madrid, Madrid, Spain.
- Optics Department, Faculty of Optics and Optometry, Universidad Complutense De Madrid, Madrid, Spain.
| | - José-Manuel López Alonso
- Optics Department, Faculty of Optics and Optometry, Universidad Complutense De Madrid, Madrid, Spain
| | - Aurora Del Río Sevilla
- Faculty of Optics and Optometry, Anatomy and Embryology Department, Universidad Complutense de Madrid, Madrid, Spain
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13
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Bukhari S, Yaghi S, Bashir Z. Stroke in Young Adults. J Clin Med 2023; 12:4999. [PMID: 37568401 PMCID: PMC10420127 DOI: 10.3390/jcm12154999] [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: 05/20/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. In addition, there are non-modifiable risk factors comprising migraine, pregnancy and postpartum state, illicit drug use, oral contraceptives and hypercoagulable state. The mechanisms causing stroke in young adults are unique and include cervical dissection, cardioembolic phenomenon, vasculitis and vasculopathy, connective tissue disease, patent foramen ovale and cerebral venous thrombosis. The diagnosis of stroke in the young population can be challenging given its myriad clinical presentations. In this document, we provide an overview of the epidemiology of stroke in young adults, explore mechanisms that may explain increasing rates of stroke in this population, and provide a critical updated overview of the existing literature on the management and prevention of stroke in young adults.
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Affiliation(s)
- Syed Bukhari
- Temple University Hospital, Philadelphia, PA 19140, USA
| | - Shadi Yaghi
- Department of Medicine, Brown University, Providence, RI 02912, USA; (S.Y.); (Z.B.)
| | - Zubair Bashir
- Department of Medicine, Brown University, Providence, RI 02912, USA; (S.Y.); (Z.B.)
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14
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Subramaniam AP, Oyedeji CI, Parikh JS, Feld JA, Strouse JJ. Cognitive-motor dual-task interference in adults with sickle cell disease. Gait Posture 2023; 102:164-170. [PMID: 37023564 PMCID: PMC10906011 DOI: 10.1016/j.gaitpost.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 01/31/2023] [Accepted: 03/15/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a genetic disorder that causes physical and cognitive impairment due to hemolysis, painful vaso-occlusion episodes, joint avascular necrosis, and strokes. As individuals with SCD age and develop conditions impacting their physical and cognitive function, their ability to multitask successfully and safely may decline. Cognitive-motor dual-task interference occurs when there is deterioration in one or both tasks while dual-tasking relative to single-tasking. Dual-task assessment (DTA) is a valuable measure of physical and cognitive function; however, there is limited data on DTA in adults with SCD. RESEARCH QUESTION Is DTA a feasible and safe method of measuring physical and cognitive function in adults with SCD? What patterns of cognitive-motor interference occur in adults with SCD? METHODS We enrolled 40 adults with SCD (mean age 44 years, range 20-71) in a single-center prospective cohort study. We used usual gait speed as the measure of motor performance and verbal fluency (F, A, and S) as the measure of cognitive performance. We measured feasibility as the proportion of consented participants able to complete the DTA. We calculated the relative dual-task effect (DTE %) for each task and identified patterns of dual-task interference. RESULTS Most consented participants completed the DTA (91%, 40/44) and there were no adverse events. There were 3 main dual-task interference patterns for the first trial using letter 'A': Motor Interference (53%, n = 21), Mutual Interference (23%, n = 9), and Cognitive-Priority Tradeoff (15%, n = 6). For the second trial using letter 'S', there were two main dual-task interference patterns: Cognitive-Priority Tradeoff (53%, n = 21) and Motor Interference (25%, n = 10). STATEMENT OF SIGNIFICANCE DTA was feasible and safe in adults with SCD. We identified specific patterns of cognitive-motor interference. This study supports further evaluation of DTA as a potentially useful tool to measure physical and cognitive function in ambulatory adults with SCD.
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Affiliation(s)
- Arvind P Subramaniam
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 40 Duke Medicine Circle - Clinic 1E, Durham, NC 27710, United States; Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 40 Duke Medicine Circle - Clinic 2N, Durham, NC 27710, United States
| | - Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 40 Duke Medicine Circle - Clinic 1E, Durham, NC 27710, United States; Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 40 Duke Medicine Circle - Clinic 2N, Durham, NC 27710, United States; Duke Claude D. Pepper Older Americans Independence Center, Duke Aging Center, Duke University Medical Center, Unit 3003, Durham, NC 27710, United States
| | - Jhana S Parikh
- Department of Anesthesiology, Duke University, 134 Research Drive, Durham, NC 27710, United States
| | - Jody A Feld
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University School of Medicine, 311 Trent Drive, Durham, NC 27710, United States
| | - John J Strouse
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 40 Duke Medicine Circle - Clinic 1E, Durham, NC 27710, United States; Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 40 Duke Medicine Circle - Clinic 2N, Durham, NC 27710, United States; Duke Claude D. Pepper Older Americans Independence Center, Duke Aging Center, Duke University Medical Center, Unit 3003, Durham, NC 27710, United States; Division of Pediatric Hematology-Oncology, Duke University, 2301 Erwin Road, Fourth Floor, Durham, NC, United States.
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15
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Chambliss C, Stiles JK, Gee BE. Neuregulin-1 attenuates hemolysis- and ischemia induced-cerebrovascular inflammation associated with sickle cell disease. J Stroke Cerebrovasc Dis 2023; 32:106912. [PMID: 36473396 PMCID: PMC10448832 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES Individuals with sickle cell disease (SCD) are at severely heightened risk for cerebrovascular injury and acute cerebrovascular events, including ischemic and hemorrhagic stroke, potentially leading to impaired development and life-long physical and cognitive disabilities. Cerebrovascular injury specific to SCD includes inflammation caused by underlying conditions of chronic hemolysis and reduced cerebrovascular perfusion. The objectives of this study were to investigate whether expression of neuregulin-1β (NRG-1), an endogenous neuroprotective polypeptide, is increased in SCD or experimental conditions mimicking the hemolysis and ischemic conditions of SCD, and to determine if treatment with exogenous NRG-1 reduces markers of cerebrovascular inflammation. MATERIALS AND METHODS Plasma and brain-specific NRG-1 levels were measured in transgenic SCD mice. Endogenous NRG-1 levels and response to experimental conditions of excess heme and ischemia were measured in cultured human brain microvascular cells and astrocytes. Pre-treatment with NRG-1 was used to determine NRG-1's ability to ameliorate resultant cerebrovascular inflammation. RESULTS Plasma and brain-specific NRG-1 were elevated in transgenic SCD mice compared to healthy controls. Neuregulin-1 expression was significantly increased in cultured human microvascular cells and astrocytes exposed to excess heme and ischemia. Pre-treatment with NRG-1 reduced inflammatory chemokine (CXCL-1 and CXCL-10) and adhesion molecule (ICAM-1 and VCAM-1) expression and increased pro-angiogenic factors (VEGF-A) in microvascular cells and astrocytes exposed to excess heme and ischemia. CONCLUSIONS Elevated NRG-1 in SCD is likely a protective endogenous response to ongoing cerebrovascular insults caused by chronic hemolysis and reduced cerebrovascular perfusion. Administration of NRG-1 to reduce cerebrovascular inflammation may be therapeutically beneficial in SCD and warrants continued investigation.
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Affiliation(s)
- Christopher Chambliss
- Pediatrics Institute, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, United States; Aflac Cancer and Blood Disorders Center, 2015 Uppergate Drive, Atlanta, GA 30322, United States; Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, United States.
| | - Jonathan K Stiles
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, United States.
| | - Beatrice E Gee
- Pediatrics Institute, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, United States; Aflac Cancer and Blood Disorders Center, 2015 Uppergate Drive, Atlanta, GA 30322, United States; Children's Healthcare of Atlanta, 35 Jesse Hill Jr Drive SE, Atlanta, GA 30303, United States; Department of Pediatrics, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, United States
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16
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Isaac E, Saherwal AA, Alam S. Systemic thrombolysis for acute central retinal artery occlusion in sickle cell disease: Case report. J Natl Med Assoc 2022; 114:589-592. [PMID: 36163059 DOI: 10.1016/j.jnma.2022.09.003] [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: 01/16/2022] [Revised: 07/13/2022] [Accepted: 09/02/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In sickle cell disease (SCD), blood oxygen content is decreased due to anemia and the Hb-SS phenotype, in particular leads to an increased blood viscosity, which limits tissue oxygen delivery. Nonetheless, vasculopathy, correlating with daytime oxygen saturation,1 thrombophilia and hyper coagulability are all underappreciated etiologies of stroke in SCD.2 As a result, there is less known about the role of systemic thrombolysis for the management of acute stroke in SCD. Given the lack of studies and cases reviewed in literature, we describe a patient with SCD found to have an acute stroke treated with both intravenous (IV) alteplase and exchange transfusion. RESULTS & DISCUSSION We describe a 42-year-old African- American man with SCD (HbSS) who presented with an acute central retinal artery occlusion (CRAO) within an hour of onset and subsequently received IV thrombolysis with alteplase. His labs were significant for HbS 91%. He had no central vascular access to undergo emergent red blood cell (RBC) exchange so interventional radiology was consulted to minimize his bleeding risk after receiving tissue plasminogen activator (tPA). A right internal jugular catheter was placed with fluoro-guidance, resulting in minimal blood loss. After two sessions of RBC exchange, his HbS decreased to 26%. He reported an improvement of vision in his left eye the day following acute management and followed up with Hematology for secondary stroke prevention. IMPLICATIONS In reviewing this case, we recommend that current clinical trials for management of acute stroke including an acute CRAO carefully consider including patients with sickle cell disease to receive simultaneous IV thrombolysis and RBC exchange. The benefits outweigh the risk of a permanent disabling deficit with significant functional impairment. And while considering care plans tailored to the projected needs of acute care management for this patient population, we also recommend implementing healthcare models that improve access to preventative care in settings where the majority of children and adults with SCD live.
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Affiliation(s)
- Estevana Isaac
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Ali A Saherwal
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shaista Alam
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
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Gillespie ML, Spring MR, Cohen RT, Klings ES. The interplay of sleep disordered breathing, nocturnal hypoxemia, and endothelial dysfunction in sickle cell disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Neurodevelopmental Outcomes in Preterm Children with Sickle Cell Disease. J Int Neuropsychol Soc 2022; 28:1039-1049. [PMID: 34839840 PMCID: PMC9148381 DOI: 10.1017/s1355617721001338] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore the combined effect of pediatric sickle cell disease (SCD) and preterm birth on cognitive functioning. METHODS Cognitive functioning was examined in children ages 6-8 with high risk SCD genotypes born preterm (n = 20) and full-term (n = 59) and lower risk SCD genotypes/no SCD born preterm (n = 11) and full-term (n = 99) using tests previously shown to be sensitive to SCD-related neurocognitive deficits. Factorial ANOVAs and log linear analyses were conducted to examine the relationship between SCD risk, preterm birth status, and cognitive outcomes. Continuous scores were examined for specific tests. Children were categorized as having an abnormal screening outcome if at least one cognitive score was ≥1.5 standard deviations below the population mean. RESULTS Children with elevated risk due to high risk SCD and preterm birth performed worse than other groups on a test of expressive language but not on tests that emphasize processing speed and working memory. There was a three-way interaction between preterm status, SCD risk, and abnormal screening outcome, which was largely driven by the increased likelihood of abnormal cognitive scores for children with high risk SCD born preterm. CONCLUSIONS The combination of SCD and preterm birth may confer increased risk for language deficits and elevated rates of abnormal cognitive screenings. This suggests that neurodevelopmental risk imparted by comorbid SCD and preterm birth may manifest as heterogenous, rather than specific, patterns of cognitive deficits. Future studies are needed to clarify the domains of cognitive functioning most susceptible to disease-related effects of comorbid SCD and preterm birth.
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Schieve LA, Simmons GM, Payne AB, Abe K, Hsu LL, Hulihan M, Pope S, Rhie S, Dupervil B, Hooper WC. Vital Signs: Use of Recommended Health Care Measures to Prevent Selected Complications of Sickle Cell Anemia in Children and Adolescents — Selected U.S. States, 2019. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1241-1246. [PMID: 36173745 PMCID: PMC9533731 DOI: 10.15585/mmwr.mm7139e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction Sickle cell disease (SCD), a group of inherited blood cell disorders that primarily affects Black or African American persons, is associated with severe complications and a >20-year reduction in life expectancy. In 2014, an expert panel convened by the National Heart, Lung, and Blood Institute issued recommendations to prevent or reduce complications in children and adolescents with the most severe SCD subtypes, known as sickle cell anemia (SCA); recommendations included 1) annual screening of children and adolescents aged 2–16 years with transcranial Doppler (TCD) ultrasound to identify those at risk for stroke and 2) offering hydroxyurea therapy to children and adolescents aged ≥9 months to reduce the risk for several life-threatening complications. Methods Data from the IBM MarketScan Multi-State Medicaid Database were analyzed. TCD screening and hydroxyurea use were examined for 3,352 children and adolescents with SCA aged 2–16 years and continuously enrolled in Medicaid during 2019. Percentage change during 2014–2019 and variation by health subgroups were assessed. Analyses were stratified by age. Results During 2014–2019, TCD screening increased 27% among children and adolescents aged 10–16 years; hydroxyurea use increased 27% among children aged 2–9 years and 23% among children and adolescents aged 10–16 years. However, in 2019, only 47% and 38% of children and adolescents aged 2–9 and 10–16 years, respectively, had received TCD screening and 38% and 53% of children and adolescents aged 2–9 years and 10–16 years, respectively, used hydroxyurea. For both prevention strategies, usage was highest among children and adolescents with high levels of health care utilization and evidence of previous complications indicative of severe disease. Conclusion and Implications for Public Health Practice Despite increases since 2014, TCD screening and hydroxyurea use remain low among children and adolescents with SCA. Health care providers should implement quality care strategies within their clinics and partner with patients, families, and community-based organizations to address barriers to delivering and receiving recommended care.
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Ogbenna AA, Akinsete AM, Kalejaiye OO, Matthew OK, Sharma D, Andrews J, Kassim AA. Reduction in seroprevalence of viral transfusion-transmitted infections in southwest Nigeria in children with sickle cell disease using an enhanced screening strategy. Br J Haematol 2022; 198:745-752. [PMID: 35719004 DOI: 10.1111/bjh.18313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/17/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022]
Abstract
Blood transfusion is an integral component in the management of children and adults with sickle cell disease (SCD). Concerns about blood safety due to the high risk of bloodborne infections in sub-Saharan Africa limits the application of this cost-effective strategy in the management of individuals with SCD. In a single-centre, retrospective, longitudinal study in southwest Nigeria, we hypothesised that the use of stringent blood donor selection, along with very sensitive enzyme-linked immunosorbent assay (ELISA) screening methods would reduce transfusion-transmitted infections (TTIs). Among 45 002 eligible blood donors at the Lagos University Teaching Hospital in Nigeria, over a 5-year review period (2015-2019), the seroprevalence rate of viral TTIs was 9.83%. The seroprevalence rates for human immunodeficiency, hepatitis B, and hepatitis C viruses were 1.37%, 6.2%, and 2.25% respectively. Among 172 children with SCD, 71% (122/172) on regular blood transfusion and 29% (50/172) who had never been transfused or had less than two transfusions per lifetime, none acquired any TTIs using our enhanced screening approach during the study period. Thus, safe blood transfusion practices can be provided for children with SCD in sub-Saharan Africa with the use of stringent donor selection protocols and fourth-generation ELISA kits for TTI screening.
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Affiliation(s)
- Ann A Ogbenna
- Department of Hematology and Blood Transfusion, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye M Akinsete
- Division of Pediatric Hematology and Oncology, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufunto O Kalejaiye
- Department of Medicine, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oyewole Kunmi Matthew
- Department of Hematology and Blood Transfusion, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Deva Sharma
- Division of Transfusion Medicine and Pediatrics, Division of Hematology/Oncology, Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Andrews
- Division of Transfusion Medicine and Pediatrics, Division of Hematology/Oncology, Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adetola A Kassim
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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21
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Clonal Hematopoiesis and the Risk of Hematologic Malignancies after Curative Therapies for Sickle Cell Disease. J Clin Med 2022; 11:jcm11113160. [PMID: 35683547 PMCID: PMC9181510 DOI: 10.3390/jcm11113160] [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: 04/28/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 12/30/2022] Open
Abstract
Sickle cell disease (SCD) is associated with severe morbidity and early mortality. Two large population studies found an increased risk for leukemia in individuals with SCD. Notably, while the relative risk of leukemia development is high, the absolute risk is low in individuals with SCD who do not receive cell-based therapies. However, the risk of leukemia in SCD is high after graft rejection and with gene therapy. Clonal hematopoiesis (CH) is a well-recognized premalignant condition in the general population and in patients after high-dose myelotoxic therapies. Recent studies suggest that CH may be more common in SCD than in the general population, outside the cell-based therapy setting. Here, we review risk factors for CH and progression to leukemia in SCD. We surmise why patients with SCD are at an increased risk for CH and why leukemia incidence is unexpectedly high after graft rejection and gene therapy for SCD. Currently, we are unable to reliably assess genetic risk factors for leukemia development after curative therapies for SCD. Given our current knowledge, we recommend counseling patients about leukemia risk and discussing the importance of an individualized benefit/risk assessment that incorporates leukemia risk in patients undergoing curative therapies for SCD.
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22
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Cui MH, Billett HH, Suzuka SM, Ambadipudi K, Archarya S, Mowrey WB, Branch CA. Corrected cerebral blood flow and reduced cerebral inflammation in berk sickle mice with higher fetal hemoglobin. Transl Res 2022; 244:75-87. [PMID: 35091127 DOI: 10.1016/j.trsl.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
Abstract
Fetal hemoglobin (HbF) is known to lessen the severity of sickle cell disease (SCD), through reductions in peripheral vaso-occlusive disease and reduced risk for cerebrovascular events. However, the influence of HbF on oxygen delivery to high metabolism tissues like the brain, or its influence on cerebral perfusion, metabolism, inflammation or function have not been widely studied. We employed a Berkley mouse model (BERK) of SCD with gamma transgenes q3 expressing exclusively human α- and βS-globins with varying levels of γ globin expression to investigate the effect of HbF expression on the brain using magnetic resonance imaging (MRI), MRI diffusion tensor imaging (DTI) and spectroscopy (MRS) and hematological parameters. Hematological parameters improved with increasing γ level expression, as did markers for brain metabolism, perfusion and inflammation. Brain microstructure assessed by DTI fractional anisotropy improved, while myo-inositol levels increased, suggesting improved microstructural integrity and reduced cell loss. Our results suggest that increasing γ levels not only improves sickle peripheral disease, but also improves brain perfusion and oxygen delivery while reducing brain inflammation while protecting brain microstructural integrity.
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Affiliation(s)
- Min-Hui Cui
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York; Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Henny H Billett
- Department of Medicine, Albert Einstein College of Medicine, New York, New York; Department of Pathology, Albert Einstein College of Medicine, New York, New York
| | - Sandra M Suzuka
- Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Kamalakar Ambadipudi
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York
| | - Seetharama Archarya
- Department of Medicine, Albert Einstein College of Medicine, New York, New York; Department of Physiology & Biophysics, Albert Einstein College of Medicine, New York, New York
| | - Wenzhu B Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, New York
| | - Craig A Branch
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York; Department of Physiology & Biophysics, Albert Einstein College of Medicine, New York, New York.
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23
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Markovic I, Milenkovic Z, Jocic-Jakubi B, Futaisi AA, Kakaria KA, Walli Y. Stroke in sickle cell disease in association with bilateral absence of the internal carotid arteries. Case report. BMC Neurol 2022; 22:182. [PMID: 35581570 PMCID: PMC9112539 DOI: 10.1186/s12883-022-02702-5] [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: 09/30/2020] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Congenital absence of the internal carotid artery (ICA) is a highly infrequent congenital incidence and occurs in less than 0.01% of the population; bilateral absence is exceedingly rare, diagnosed below 10% of the unilateral absence of the ICA. Sickle cell disease (SCD) is a serious disorder and carries a high risk of stroke. Case presentation We present a five-year-old child with SCD who experienced an ischemic stroke episode with epileptic seizures. Neuroimaging revealed the agenesis of both ICAs. The frequency, embryology, and collateral pathway of the vascular anomaly as the clinical presentation, of this rare hematologic disease, are discussed. Conclusions Sickle cell disease (SCD) carries a high risk of stroke. Congenital absence of ICA occurs in less than 0.01% of the population; bilateral absence is diagnosed below 10% of the unilateral absence of the ICA.
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Affiliation(s)
- Ivana Markovic
- IvanaMarkovic, Sultan Qaboos University Hospital, Radiology Department, Muscat, Oman
| | - Zoran Milenkovic
- General Hospital "Sava Surgery", Kej 29 Decembar 2, Niš, 18000, Serbia.
| | | | - Amna Al Futaisi
- Hospital, Child Health, Sultan Qaboos University Hospital, College of Medicine and Health Sciences, Muscat, Oman
| | - Kakaria Anupam Kakaria
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yasser Walli
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
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24
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Reeves SL, Freed GL, Madden B, Wu M, Miller L, Cogan L, Anders D, Creary SE, McCormick J, Dombkowski KJ. Trends in quality of care among children with sickle cell anemia. Pediatr Blood Cancer 2022; 69:e29446. [PMID: 34854548 PMCID: PMC9367210 DOI: 10.1002/pbc.29446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION For decades, it has been recommended that children with sickle cell anemia (SCA) receive antibiotic prophylaxis to prevent serious infections and undergo transcranial Doppler (TCD) screening to identify those at highest risk of overt stroke. We assessed recent temporal trends in antibiotic prophylaxis prescription fills and TCD screening among children with SCA using validated quality measures. PROCEDURE Using validated claims-based definitions, we identified children with SCA who were enrolled in Michigan or New York State (NYS) Medicaid programs (2011-2018). Among recommended age groups, two outcomes were assessed yearly: (a) filling of ≥300 days of antibiotics, and (b) receipt of greater than or equal to one TCD. The proportion of children with each outcome was calculated by state. Temporal trends in each preventive service were assessed using generalized linear models. RESULTS A total of 1784 children were eligible for antibiotic prophylaxis (Michigan: 384; NYS: 1400), contributing 3322 person-years. Annual rates of filling ≥300 days of antibiotics ranged from 16% to 22% and were similar by state. There was no change in rates of antibiotic filling over time in Michigan (p-value: .10), but there was a decrease in NYS (p-value: .02). A total of 3439 children with SCA were eligible for TCD screening (Michigan: 710; NYS: 2729), contributing 10,012 person-years. Annual rates of TCD screening ranged from 39% to 45%, were similar by state, and did not change over time (p-values >.05). CONCLUSIONS Most children with SCA do not receive recommended antibiotic prophylaxis and/or TCD screening. New, sustainable, and coordinated interventions across preventive services are urgently needed.
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Affiliation(s)
- Sarah L Reeves
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI;,Department of Epidemiology; University of Michigan; Ann Arbor, MI
| | - Gary L Freed
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI
| | - Brian Madden
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI
| | - Meng Wu
- New York State Department of Health; Albany, NY
| | | | | | | | - Susan E Creary
- Department of Pediatrics; Nationwide Children’s; Columbus, OH
| | - Julie McCormick
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI
| | - Kevin J Dombkowski
- Susan B Meister Child Health Evaluation and Research Center; Department of Pediatrics; University of Michigan; Ann Arbor, MI
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25
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Adanho CSA, Yahouédéhou SCMA, Santana SS, Vieira C, Santiago RP, de Santana JM, Pitanga TN, Aleluia MM, Maffili VV, Leite IPR, Zanette DL, Lyra IM, Goncalves MS. Association of laboratory markers and cerebral blood flow among sickle cell anemia children. Front Pediatr 2022; 10:914466. [PMID: 36090571 PMCID: PMC9458965 DOI: 10.3389/fped.2022.914466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stroke is one of the highest complications of sickle-cell anemia (SCA). The Transcranial Doppler (TCD) has been adopted worldwide as a gold standard method for detecting alterations in the blood velocity in cerebral arteries. In this study, we investigated the association between laboratory parameters and increased cerebral blood flow velocity in Brazilian SCA pediatric patients. METHODS The study included 159 pediatric patients with SCA, submitted to TCD velocity screening, and the time-averaged maximum mean velocity (TAMMV) was determined in the middle cerebral artery (MCA), anterior cerebral artery (ACA), and distal intracranial internal carotid artery (ICA). We compared cerebral blood flow in patients stratified by the following: TCD1-defined as normal, with TAMMV inferior to 170 cm/s; TCD2-conditional, with TAMMV above 170 cm/s, but less than 199 cm/s; TCD3-altered, with TAMMV greater than or equal to 200 cm/s. RESULTS TAMMV was negatively correlated with age and weight (p < 0.05). Moreover, TAMMV was associated or correlated with reductions in HbF, RBC, hemoglobin, hematocrit, HDL, and haptoglobin and, increases in MCV, MCH, RDW, reticulocytes, WBC, lymphocytes, monocytes, eosinophils, total and indirect bilirubin, LDH, AST, ALT, glucose, ferritin, and AAT (p < 0.05). CONCLUSION The current study highlights the importance of the investigation of hemolytic and inflammatory biomarkers for monitoring the clinical outcome of SCA pediatric patients, to avoid acute or chronic stroke. Moreover, glucose and HDL-C appear useful for predicting higher TAMMV.
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Affiliation(s)
- Corynne Stéphanie Ahouéfa Adanho
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Sètondji Cocou Modeste Alexandre Yahouédéhou
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Sânzio Silva Santana
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Faculdade de Biomedicina, Universidade Católica do Salvador, Salvador, Bahia, Brazil
| | - Camilo Vieira
- Ambulatório Pediátrico de Doença Cerebrovascular, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Rayra Pereira Santiago
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Jeanne Machado de Santana
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Thassila Nogueira Pitanga
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Faculdade de Biomedicina, Universidade Católica do Salvador, Salvador, Bahia, Brazil
| | | | - Vítor Valério Maffili
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Ivana Paula Ribeiro Leite
- Serviço de Pediatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Dalila Luciola Zanette
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Isa Menezes Lyra
- Serviço de Pediatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Ambulatório, Fundação de Hematologia e Hemoterapia da Bahia, Salvador, Bahia, Brazil.,Curso de Medicina, Escola de Ciências da Saúde e Bem-Estar, Universidade Salvador, Salvador, Bahia, Brazil
| | - Marilda Souza Goncalves
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Salvador, Bahia, Brazil.,Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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26
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Keith KA, Reed LK, Nguyen A, Qaiser R. Neurovascular Syndromes. Neurosurg Clin N Am 2021; 33:135-148. [PMID: 34801137 DOI: 10.1016/j.nec.2021.09.010] [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: 10/19/2022]
Abstract
Patients with cerebrovascular syndromes are at risk for additional concerns associated with their syndrome. A wide variety of syndromes are associated with cerebrovascular diseases. Multidisciplinary care is helpful to ensure comprehensive evaluation and management. Precise diagnosis and appreciation for the underlying syndrome is critical for effective cerebrovascular and broader care. This text focuses on these conditions with a focus on underlying pathophysiology and associated genetics, presentation, diagnosis, and management of each disease.
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Affiliation(s)
- Kristin A Keith
- Baylor Scott & White Health/Texas A&M Neurosurgery Department, 2401 South 31st Street, MS-01-610A, Temple, TX 76508, USA
| | - Laura K Reed
- Baylor Scott & White Health/Texas A&M Neurosurgery Department, 2401 South 31st Street, MS-01-610A, Temple, TX 76508, USA
| | - Anthony Nguyen
- Baylor Scott & White Health/Texas A&M Neurosurgery Department, 2401 South 31st Street, MS-01-610A, Temple, TX 76508, USA
| | - Rabia Qaiser
- Baylor Scott & White Health/Texas A&M Neurosurgery Department, 2401 South 31st Street, MS-01-610A, Temple, TX 76508, USA.
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27
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Oz O, Gonel A. The Association Between Parameters of Erythrocytes Morphology and Thrombophilia-Related Mutations. Rev Recent Clin Trials 2021; 17:40-45. [PMID: 34814821 DOI: 10.2174/1574887116666211123092603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alterations in erythrocyte morphology parameters have been identified and associated with hematological disorders and other chronic and cardiovascular diseases. Erythrocytes are abundant in thrombus content. Their hemoglobin density and differences in the ratio of macrocytic and microcytic cells may be associated with hypercoagulopathy in those with a history of thrombosis. OBJECTIVE This cross-sectional study aimed to investigate the relationship between hemogram parameters and thrombophilia genetic parameters. METHOD A total of 55 patients whose thrombophilia panel was reviewed due to the diagnosis of thrombosis were included in the study. %MIC, %MAC, %HPO, %HPR and all hemogram parameters were measured using Abbott Alinity HQ. Prothrombin G20210A, MTHFR C677T, MTHFR A1298C, Factor V Leiden G169A and PAI-1 4G/5G mutations were studied using Real Time-PCR. RESULTS The MTHFR C677T mutation was detected in 58.2% of the patients. The Factor V Leiden mutation was detected in 5.5% of the patients. The MTHFR A1298C mutation was detected in 58.2%, The PAI mutation was detected in 74.5%, and the Factor 13 mutation was detected in 29% of the patients. Prothrombin G20210A mutation was not detected in any of the patients. Red blood cell (RBC) and Hct values were higher in Factor 13 mutant group; the Hgb and Htc values were higher in the MTHFR C677T mutant group. CONCLUSION The MTHFR C677T and Factor 13 mutations may be associated with high Hct and RBC, Hgb, and Htc values, respectively and coagulation tendency in patients with a history of thrombosis.
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Affiliation(s)
- Ozlem Oz
- Department of Medical Genetics, Harran University. Turkey
| | - Ataman Gonel
- Department of Medicinal Biochemistry, Harran University. Turkey
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28
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Prapiadou S, Demel SL, Hyacinth HI. Genetic and Genomic Epidemiology of Stroke in People of African Ancestry. Genes (Basel) 2021; 12:1825. [PMID: 34828431 PMCID: PMC8619587 DOI: 10.3390/genes12111825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke is one of the leading causes of disability and death worldwide and places a significant burden on healthcare systems. There are significant racial/ethnic differences in the incidence, subtype, and prognosis of stroke, between people of European and African ancestry, of which only about 50% can be explained by traditional stroke risk facts. However, only a small number of genetic studies include individuals of African descent, leaving many gaps in our understanding of stroke genetics among this population. This review article highlights the need for and significance of including African-ancestry individuals in stroke genetic studies and points to the efforts that have been made towards this direction. Additionally, we discuss the caveats, opportunities, and next steps in African stroke genetics-a field still in its infancy but with great potential for expanding our understanding of stroke biology and for developing new therapeutic strategies.
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Affiliation(s)
- Savvina Prapiadou
- Department of Medicine, University of Patras School of Medicine, 26223 Patras, Greece;
| | - Stacie L. Demel
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45221, USA;
| | - Hyacinth I. Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45221, USA;
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29
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Kumar S, Andoniadis M, Solhpour A, Asghar S, Fangman M, Ashouri R, Doré S. Contribution of Various Types of Transfusion to Acute and Delayed Intracerebral Hemorrhage Injury. Front Neurol 2021; 12:727569. [PMID: 34777198 PMCID: PMC8586553 DOI: 10.3389/fneur.2021.727569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the second most prevalent type of stroke, after ischemic stroke, and has exceptionally high morbidity and mortality rates. After spontaneous ICH, one primary goal is to restrict hematoma expansion, and the second is to limit brain edema and secondary injury. Various types of transfusion therapies have been studied as treatment options to alleviate the adverse effects of ICH etiopathology. The objective of this work is to review transfusions with platelets, fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), and red blood cells (RBCs) in patients with ICH. Furthermore, tranexamic acid infusion studies have been included due to its connection to ICH and hematoma expansion. As stated, the first line of therapy is limiting bleeding in the brain and hematoma expansion. Platelet transfusion is used to promote recovery and mitigate brain damage, notably in patients with severe thrombocytopenia. Additionally, tranexamic acid infusion, FFP, and PCC transfusion have been shown to affect hematoma expansion rate and volume. Although there is limited available research, RBC transfusions have been shown to cause higher tissue oxygenation and lower mortality, notably after brain edema, increases in intracranial pressure, and hypoxia. However, these types of transfusion have varied results depending on the patient, hemostasis status/blood thinner, hemolysis, anemia, and complications, among other variables. Inconsistencies in published results on various transfusion therapies led us to review the data and discuss issues that need to be considered when establishing future guidelines for patients with ICH.
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Affiliation(s)
- Siddharth Kumar
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Matthew Andoniadis
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Ali Solhpour
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Salman Asghar
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Madison Fangman
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Rani Ashouri
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Sylvain Doré
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States.,Departments of Psychiatry, Pharmaceutics, Psychology, and Neuroscience, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
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Relationships of Ischemic Stroke Occurrence and Outcome with Gene Variants Encoding Enzymes of Tryptophan Metabolism. Biomedicines 2021; 9:biomedicines9101441. [PMID: 34680558 PMCID: PMC8533114 DOI: 10.3390/biomedicines9101441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 12/29/2022] Open
Abstract
Ischemic stroke is among the leading causes of mortality and long-term disability worldwide. Among stroke risk factors the importance of genetic background is gaining interest. There is a growing body of evidence of changes of metabolite levels and enzyme activities involved in the conversion of Trp during the course of cerebral ischemia. We compared the frequencies of ten SNPs of five genes related to Trp metabolism between groups of 122 ischemic stroke patients and 120 control individuals. Furthermore, we examined the mRNA levels of TPH1, IDO1 and KYAT1 genes in peripheral venous blood with the aim of assessing (i) whether there are changes in their expression during the course of stroke and (ii) does any of their investigated SNPs have an impact on gene expression. In seven cases out of ten studied polymorphisms we detected significant differences in frequencies in relation to ischemic stroke occurrence, etiology, and clinical parameters. We also detected changes in the expression of TPH1 and IDO1 genes during the course of the disease. We found that those IDO1 variants which show a trend towards elevated mRNA level are more frequent in stroke patients than in controls. Our results are important novel observations which suggest a causal relationship between elevated IDO1 expression and stroke etiology.
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Miller R, Klyde DM, Unda SR, Fluss R, Altschul DJ. Classical Risk Factors for Ischemic Stroke are not Associated with Inpatient Post-Stroke Mortality in Sickle Cell Disease. J Stroke Cerebrovasc Dis 2021; 30:106089. [PMID: 34551382 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106089] [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: 05/09/2021] [Revised: 07/22/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Sickle cell disease is a common haemoglobinopathy that significantly increases the risk of ischemic stroke. Because the risk factors for ischemic stroke onset and mortality in non-sickle cell disease patients have been largely elucidated, this paper aims to analyze risk factors for ischemic stroke mortality in sickle cell disease patients, which remain largely unknown. MATERIALS/METHODS The National Inpatient Sample database (2016-2017) was used to develop a multivariable regression model for risk quantification of known ischemic stroke risk factors for in-hospital mortality in ischemic stroke patients with and without sickle cell disease. RESULTS Classical risk factors for ischemic stroke onset, including ischemic heart disease, carotid artery disease, lipidemias, hypertension, obesity, tobacco use, atrial fibrillation, personal or family history of stroke, congenital heart defects, congestive heart failure, cardiac valve disorder, peripheral vascular disease, and diabetes mellitus are associated with in-hospital mortality in non-sickle cell patients (p < 0.05). However, no significant association was found between these stroke risk factors and in-hospital mortality in sickle cell disease patients presenting with ischemic stroke (p > 0.05). CONCLUSIONS While the classical risk factors for stroke onset are associated with in-hospital mortality in non-sickle cell stroke patients, they are not associated with in-hospital mortality in sickle cell stroke patients.
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Affiliation(s)
- Raphael Miller
- Albert Einstein College of Medicine, Bronx, NY 10461***, USA
| | - Daniel M Klyde
- Albert Einstein College of Medicine, Bronx, NY 10461***, USA.
| | | | - Rose Fluss
- Montefiore Medical Center, Bronx, NY 10467, USA
| | - David J Altschul
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Ave., Bronx, NY 10467, USA
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Mathur T, Flanagan JM, Jain A. Tripartite collaboration of blood-derived endothelial cells, next generation RNA sequencing and bioengineered vessel-chip may distinguish vasculopathy and thrombosis among sickle cell disease patients. Bioeng Transl Med 2021; 6:e10211. [PMID: 34589594 PMCID: PMC8459595 DOI: 10.1002/btm2.10211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
Sickle cell disease (SCD) is the most prevalent inherited blood disorder in the world. But the clinical manifestations of the disease are highly variable. In particular, it is currently difficult to predict the adverse outcomes within patients with SCD, such as, vasculopathy, thrombosis, and stroke. Therefore, for most effective and timely interventions, a predictive analytic strategy is desirable. In this study, we evaluate the endothelial and prothrombotic characteristics of blood outgrowth endothelial cells (BOECs) generated from blood samples of SCD patients with known differences in clinical severity of the disease. We present a method to evaluate patient-specific vaso-occlusive risk by combining novel RNA-seq and organ-on-chip approaches. Through differential gene expression (DGE) and pathway analysis we find that BOECs from SCD patients exhibit an activated state through cell adhesion molecule (CAM) and cytokine signaling pathways among many others. In agreement with clinical symptoms of patients, DGE analyses reveal that patient with severe SCD had a greater extent of endothelial activation compared to patient with milder symptoms. This difference is confirmed by performing qRT-PCR of endothelial adhesion markers like E-selectin, P-selectin, tissue factor, and Von Willebrand factor. Finally, the differential regulation of the proinflammatory phenotype is confirmed through platelet adhesion readouts in our BOEC vessel-chip. Taken together, we hypothesize that these easily blood-derived endothelial cells evaluated through RNA-seq and organ-on-chips may serve as a biotechnique to predict vaso-occlusive episodes in SCD patients and will ultimately allow better therapeutic interventions.
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Affiliation(s)
- Tanmay Mathur
- Department of Biomedical EngineeringTexas A&M UniversityCollege StationTexasUSA
| | - Jonathan M. Flanagan
- Department of Pediatrics, Section of Hematology‐OncologyBaylor College of MedicineHoustonTexasUSA
| | - Abhishek Jain
- Department of Biomedical EngineeringTexas A&M UniversityCollege StationTexasUSA
- Department of Medical PhysiologyCollege of Medicine, Texas A&M Health Science CenterBryanTexasUSA
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Rankine-Mullings A, Reid M, Soares D, Taylor-Bryan C, Wisdom-Phipps M, Aldred K, Latham T, Schultz WH, Knight-Madden J, Badaloo A, Lane A, Adams RJ, Ware RE. Hydroxycarbamide treatment reduces transcranial Doppler velocity in the absence of transfusion support in children with sickle cell anaemia, elevated transcranial Doppler velocity, and cerebral vasculopathy: the EXTEND trial. Br J Haematol 2021; 195:612-620. [PMID: 34291449 DOI: 10.1111/bjh.17698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
EXpanding Treatment for Existing Neurological Disease (EXTEND) investigated whether hydroxycarbamide lowers transcranial Doppler (TCD) velocities in Jamaican children with sickle cell anaemia (SCA) and elevated TCD velocity with or without previous stroke. Forty-three children (age 2-17 years) with baseline maximum time-averaged mean velocity (TAMV) ≥ 170 cm/s were stratified into three risk categories based on treatment status and stroke history: Group 1 (no history of stroke, on hydroxycarbamide, n = 12); and Groups 2 (no stroke, no hydroxycarbamide, n = 21) and 3 (previous stroke, no hydroxycarbamide, n = 10). Open-label hydroxycarbamide at 20 mg/kg/day was commenced, with escalation to maximum tolerated dose (MTD) based on mild marrow suppression (average dose 25·4 ± 4·5 mg/kg/day). TCD was performed every six months with brain magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) at baseline and after 18-months of hydroxycarbamide. The maximum TAMV decreased significantly compared to baseline (24 ± 30 cm/s, P < 0·0001), with similar declines in all groups. Clinical stroke occurred in five children, one in Group 1, none in Group 2, and four in Group 3, P = 0·0032, comparing group incidence rates. Brain MRI/MRA was stable in children without clinical stroke. EXTEND documents the feasibility and benefits of hydroxycarbamide at MTD to lower TCD velocities and reduce stroke risk in children with SCA and no history of primary stroke in low-resource settings without transfusion management.
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Affiliation(s)
- Angela Rankine-Mullings
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Marvin Reid
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Kingston, Jamaica
| | - Deanne Soares
- Radiology Section, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston, Jamaica
| | - Carolyn Taylor-Bryan
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Kingston, Jamaica
| | - Margaret Wisdom-Phipps
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Karen Aldred
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Teresa Latham
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William H Schultz
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Knight-Madden
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Asha Badaloo
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Kingston, Jamaica
| | - Adam Lane
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert J Adams
- Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Chambliss C, Richardson T, Onyekaba J, Cespedes J, Nti A, Harp KO, Buchanan-Perry I, Stiles JK, Gee BE. Elevated neuregulin-1 β levels correlate with plasma biomarkers of cerebral injury and high stroke risk in children with sickle cell anemia. ENDOCRINE AND METABOLIC SCIENCE 2021; 3:100088. [PMID: 35935682 PMCID: PMC9351492 DOI: 10.1016/j.endmts.2021.100088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Stroke, or cerebral infarction, is one of the most serious complications of sickle cell anemia (SCA) in childhood, potentially leading to impaired development and life-long physical and cognitive disabilities. About one in ten children with SCA are at risk for developing overt stroke and an additional 25% may develop silent cerebral infarcts. This is largely due to underlying cerebral injury caused by chronic cerebral ischemia and vascular insult associated with SCA. We previously identified two elevated markers of cerebral injury, plasma brain-derived neurotropic factor (BDNF) and platelet-derived growth factor (PDGF)-AA, in children with SCA and high stroke risk. The objective of this study was to investigate whether neuregulin-1β (NRG-1), an endogenous neuroprotective polypeptide may also be elevated in children with SCA. Neuregulin-1β is involved in the preservation of blood brain barrier integrity and brain microvascular cell viability and is cytoprotective in conditions of heme-induced injury and ischemia. Since elevated plasma heme and ischemia are signature characteristics of SCA, we hypothesized that NRG-1 would be elevated in children with SCA, and that NRG-1 levels would also correlate with our biomarkers of cerebral injury. Plasma NRG-1, BDNF and PDGF-AA levels were measured in children with SCA and healthy Controls. Plasma NRG-1 was found to be nearly five-fold higher in those children with SCA compared to Controls. Neuregulin-1β was also positively correlated with both BDNF and PDGF-AA concentrations, but was not associated with degree of anemia, suggesting that NRG-1 production may be an endogenous response to subclinical cerebral ischemia in SCA warranting further exploration.
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Affiliation(s)
- Christopher Chambliss
- Cardiovascular Research Institute, Morehouse School of Medicine; 720 Westview Drive SW, Atlanta, GA 30310, USA,Corresponding author. (C. Chambliss)
| | | | - John Onyekaba
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine; 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Juan Cespedes
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine; 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Annette Nti
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine; 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Keri Oxendine Harp
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine; 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Iris Buchanan-Perry
- Department of Pediatrics, Morehouse School of Medicine; 720 Westview Drive SW, Atlanta, GA 30310, USA,Children’s Healthcare of Atlanta; 35 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | - Jonathan K. Stiles
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine; 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Beatrice E. Gee
- Department of Pediatrics, Morehouse School of Medicine; 720 Westview Drive SW, Atlanta, GA 30310, USA,Children’s Healthcare of Atlanta; 35 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA,Aflac Cancer and Blood Disorders Center; 2015 Uppergate Drive, Atlanta, GA 30322, USA,Pediatrics Institute, Emory University School of Medicine; 2015 Uppergate Drive, Atlanta, GA, 30322, USA
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35
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Critical Role of Hemopexin Mediated Cytoprotection in the Pathophysiology of Sickle Cell Disease. Int J Mol Sci 2021; 22:ijms22126408. [PMID: 34203861 PMCID: PMC8232622 DOI: 10.3390/ijms22126408] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 02/07/2023] Open
Abstract
Circulating hemopexin is the primary protein responsible for the clearance of heme; therefore, it is a systemic combatant against deleterious inflammation and oxidative stress induced by the presence of free heme. This role of hemopexin is critical in hemolytic pathophysiology. In this review, we outline the current research regarding how the dynamic activity of hemopexin is implicated in sickle cell disease, which is characterized by a pathological aggregation of red blood cells and excessive hemolysis. This pathophysiology leads to symptoms such as acute kidney injury, vaso-occlusion, ischemic stroke, pain crises, and pulmonary hypertension exacerbated by the presence of free heme and hemoglobin. This review includes in vivo studies in mouse, rat, and guinea pig models of sickle cell disease, as well as studies in human samples. In summary, the current research indicates that hemopexin is likely protective against these symptoms and that rectifying depleted hemopexin in patients with sickle cell disease could improve or prevent the symptoms. The data compiled in this review suggest that further preclinical and clinical research should be conducted to uncover pathways of hemopexin in pathological states to evaluate its potential clinical function as both a biomarker and therapy for sickle cell disease and related hemoglobinopathies.
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36
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The Mystery of Red Blood Cells Extracellular Vesicles in Sleep Apnea with Metabolic Dysfunction. Int J Mol Sci 2021; 22:ijms22094301. [PMID: 33919065 PMCID: PMC8122484 DOI: 10.3390/ijms22094301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022] Open
Abstract
Sleep is very important for overall health and quality of life, while sleep disorder has been associated with several human diseases, namely cardiovascular, metabolic, cognitive, and cancer-related alterations. Obstructive sleep apnea (OSA) is the most common respiratory sleep-disordered breathing, which is caused by the recurrent collapse of the upper airway during sleep. OSA has emerged as a major public health problem and increasing evidence suggests that untreated OSA can lead to the development of various diseases including neurodegenerative diseases. In addition, OSA may lead to decreased blood oxygenation and fragmentation of the sleep cycle. The formation of free radicals or reactive oxygen species (ROS) can emerge and react with nitric oxide (NO) to produce peroxynitrite, thereby diminishing the bioavailability of NO. Hypoxia, the hallmark of OSA, refers to a decline of tissue oxygen saturation and affects several types of cells, playing cell-to-cell communication a vital role in the outcome of this interplay. Red blood cells (RBCs) are considered transporters of oxygen and nutrients to the tissues, and these RBCs are important interorgan communication systems with additional functions, including participation in the control of systemic NO metabolism, redox regulation, blood rheology, and viscosity. RBCs have been shown to induce endothelial dysfunction and increase cardiac injury. The mechanistic links between changes of RBC functional properties and cardiovascular are largely unknown. Extracellular vesicles (EVs) are secreted by most cell types and released in biological fluids both under physiological and pathological conditions. EVs are involved in intercellular communication by transferring complex cargoes including proteins, lipids, and nucleic acids from donor cells to recipient cells. Advancing our knowledge about mechanisms of RBC-EVs formation and their pathophysiological relevance may help to shed light on circulating EVs and to translate their application to clinical practice. We will focus on the potential use of RBC-EVs as valuable diagnostic and prognostic biomarkers and state-specific cargoes, and possibilities as therapeutic vehicles for drug and gene delivery. The use of RBC-EVs as a precision medicine for the diagnosis and treatment of the patient with sleep disorder will improve the prognosis and the quality of life in patients with cardiovascular disease (CVD).
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37
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Kogel F, Hakimeh D, Sodani P, Lang P, Kühl JS, Hundsdoerfer P, Künkele A, Eggert A, Oevermann L, Schulte JH. Allogeneic hematopoietic stem cell transplantation from sibling and unrelated donors in pediatric patients with sickle cell disease-A single center experience. Pediatr Transplant 2021; 25:e13892. [PMID: 33098344 DOI: 10.1111/petr.13892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
HSCT is curative in SCD. Patients with HLA-identical sibling donor have an excellent outcome ranging from 90%-100% overall and event-free survival. However, due to the lack of matched sibling donors this option is out of reach for 70% of patients with SCD. The pool of potential donors needs to be extended. Transplantations from HLA-matched unrelated donors were reported to be less successful with shorter event-free survival and higher incidences of complications including graft-vs-host disease, especially in patients with advanced stage SCD. Here we report transplantation outcomes for 25 children with SCD transplanted using HLA-matched grafts from related or unrelated donors. Overall survival was 100% with no severe (grade III-IV) graft-vs-host disease and a 12% rejection rate. Mixed donor chimerisms only occurred in transplantations from siblings, while transplantations from unrelated donors resulted in either complete donor chimerism or rejection. Despite the small patient number, overall and disease-free survival for unrelated donor transplantations is excellent in this cohort. The advanced disease state, higher alloreactive effect and stronger immunosuppression in unrelated donor transplantations raises patient risk, for which possible solutions could be found in optimization of transplant preparation, graft manipulation or haploidentical transplantation using T cell receptor α/β-depleted grafts.
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Affiliation(s)
- Friederike Kogel
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dani Hakimeh
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pietro Sodani
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Lang
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Pediatric Hematology and Oncology, University Hospital, Tübingen, Germany
| | - Jörn-Sven Kühl
- Department of Pediatric Oncology, Hematology, and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Patrick Hundsdoerfer
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Pediatrics, Helios-Klinikum Berlin-Buch, Berlin, Germany
| | - Annette Künkele
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angelika Eggert
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Oevermann
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes H Schulte
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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Bazzi MS, Valdez JM, Barocas VH, Wood DK. An Experimental-Computational Approach to Quantify Blood Rheology in Sickle Cell Disease. Biophys J 2020; 119:2307-2315. [PMID: 33096079 PMCID: PMC7732763 DOI: 10.1016/j.bpj.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/02/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023] Open
Abstract
In sickle cell disease, aberrant blood flow due to oxygen-dependent changes in red cell biomechanics is a key driver of pathology. Most studies to date have focused on the potential role of altered red cell deformability and blood rheology in precipitating vaso-occlusive crises. Numerous studies, however, have shown that sickle blood flow is affected even at high oxygen tensions, suggesting a potentially systemic role for altered blood flow in driving pathologies, including endothelial dysfunction, ischemia, and stroke. In this study, we applied a combined experimental-computation approach that leveraged an experimental platform that quantifies sickle blood velocity fields under a range of oxygen tensions and shear rates. We computationally fitted a continuum model to our experimental data to generate physics-based parameters that capture patient-specific rheological alterations. Our results suggest that sickle blood flow is altered systemically, from the arterial to the venous circulation. We also demonstrated the application of this approach as a tool to design patient-specific transfusion regimens. Finally, we demonstrated that patient-specific rheological parameters can be combined with patient-derived vascular models to identify patients who are at higher risk for cerebrovascular complications such as aneurysm and stroke. Overall, this study highlights that sickle blood flow is altered systemically, which can drive numerous pathologies, and this study demonstrates the potential utility of an experimentally parameterized continuum model as a predictive tool for patient-specific care.
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Affiliation(s)
- Marisa S Bazzi
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - José M Valdez
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Victor H Barocas
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - David K Wood
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota.
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Payne AB, Mehal JM, Chapman C, Haberling DL, Richardson LC, Bean CJ, Hooper WC. Trends in Sickle Cell Disease-Related Mortality in the United States, 1979 to 2017. Ann Emerg Med 2020; 76:S28-S36. [PMID: 32928459 DOI: 10.1016/j.annemergmed.2020.08.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE We provide an updated assessment of trends in sickle cell disease (SCD)-related mortality, a significant source of mortality in the United States among black persons, using 1979 to 2017 US mortality data. METHODS SCD-related deaths were identified with International Classification of Diseases codes. Because SCD-related death is rare in other races, the analysis focused on black decedents. Age-specific and average annual SCD-related death rates were calculated. Causes of death codes were categorized into 20 groups relevant to SCD outcomes. SCD-related deaths were compared with non-SCD-related deaths after matching on race, sex, age group, and year of death. RESULTS There were 25,665 SCD-related deaths reported among blacks in the United States from 1979 through 2017. During that period, the annual SCD-related death rate declined in children and increased in adults, and the median age at death increased from 28 to 43 years. Acute causes of death, such as infection and cerebrovascular complications, were more common in younger age groups. Chronic complications were more common in adults. SCD-related deaths were more likely to be related to acute cardiac, pulmonary, and cerebrovascular complications; acute infections; and chronic cardiac and pulmonary complications and renal disorders; and less likely to be related to drug overdose and chronic infections than non-SCD-related deaths. CONCLUSION These data indicate SCD-related deaths are now more likely to be related to chronic complications of the disease than to acute complications. More research regarding prevention and treatment of chronic complications of SCD is necessary because persons with SCD are living longer.
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Affiliation(s)
- Amanda B Payne
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Jason M Mehal
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christina Chapman
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dana L Haberling
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christopher J Bean
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - W Craig Hooper
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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40
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Oyedeji CI, Hall K, Luciano A, Morey MC, Strouse JJ. Geriatric assessment for older adults with sickle cell disease: protocol for a prospective cohort pilot study. Pilot Feasibility Stud 2020; 6:131. [PMID: 32974042 PMCID: PMC7495855 DOI: 10.1186/s40814-020-00673-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background The life expectancy for people with sickle cell disease (SCD) has improved tremendously over the last 50 years. This population experiences hemolysis and vaso-occlusion in multiple organs that lead to complications such as cardiopulmonary disease, strokes, and avascular necrosis. These complications can limit mobility and aerobic endurance, similar to limitations that often occur in geriatric populations. These sickle-cell and age-related events lead to frequent hospitalization, which further increases the risk of functional decline. We have few tools to measure functional decline in people with SCD. The purpose of this paper is to describe a protocol to evaluate the feasibility of sickle cell disease geriatric assessment (SCD-GA). Methods/design We will enroll 40 adults with SCD (20 age 18–49.99 years and 20 age ≥ 50 years) in a prospective cohort study to assess the feasibility of SCD-GA. The SCD-GA includes validated measures from the oncology geriatric assessment enriched with additional physical and cognitive measures. The SCD-GA will be performed at the first study visit, at 10 to 20 days after hospitalization, and at 12 months (exit visit). With input from a multidisciplinary team of sickle cell specialists, geriatricians, and experts in physical function and physical activity, we selected assessments across 7 domains: functional status (11 measures), comorbid medical conditions (1 measure), psychological state (1 measure), social support (2 measures), weight status (2 measures), cognition (3 measures), and medications (1 measure). We will measure the proportion completing the assessment with feasibility as the primary outcome. Secondary outcomes include the proportion consenting and completing all study visits, duration of the assessment, acceptability, and adverse events. Discussion We present the protocol and rationale for selection of the measures included in SCD-GA. We also outline the methods to determine feasibility and subsequently to optimize the SCD-GA in preparation for a larger multicenter validation study of the SCD-GA.
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Affiliation(s)
- Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 315 Trent Dr. Suite 261, DUMC Box 3939, Durham, NC 27710 USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA
| | - Katherine Hall
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC USA
| | - Alison Luciano
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA
| | - Miriam C Morey
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC USA
| | - John J Strouse
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 315 Trent Dr. Suite 261, DUMC Box 3939, Durham, NC 27710 USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, Durham, NC USA.,Division of Pediatric Hematology-Oncology, Duke University, Durham, NC USA
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Abstract
The term "sickle cell disease" covers a group of genetic blood disorders caused by sickle hemoglobin (HbS) alone or in combination with other variants of the β‑globin locus. Sickle cell disease occurs frequently in sub-Saharan Africa, but is also common in Turkey, Greece, Sicily, the Middle East, India, and the Americas. Polymerization of deoxygenated sickle hemoglobin leads to decreased deformability of red blood cells. These altered erythrocytes can obstruct small blood vessels and cause acute episodes of pain, hemolytic anemia, and organ damage. Complications can vary between the different genotypes and it is important to be aware of the special features of the disease. Hydroxycarbamide has been shown to reduce the morbidity and mortality of patients with sickle cell disease. New drugs and novel treatment approaches such as gene therapy are currently being tested.
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Affiliation(s)
- L Distelmaier
- Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Rudower Str. 48, 12351, Berlin, Deutschland. .,Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Deutschland.
| | - U Dührsen
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Deutschland
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42
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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: 26] [Impact Index Per Article: 6.5] [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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43
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Affiliation(s)
- Mary G. George
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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44
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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: 7] [Impact Index Per Article: 1.8] [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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45
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Lin J, Morrone K, Manwani D, Chernin R, Silver EJ, Shifteh K, Sin S, Arens R, Graw-Panzer K. Association Between Periodic Limb Movements in Sleep and Cerebrovascular Changes in Children With Sickle Cell Disease. J Clin Sleep Med 2019; 15:1011-1019. [PMID: 31383239 DOI: 10.5664/jcsm.7884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Periodic limb movements (PLMs) have been associated with increased risk of stroke, but there is currently scarce research exploring this relationship in the setting of sickle cell disease (SCD). The aim of this study was to explore whether increased PLMs in children with SCD are associated with increased risk of cerebrovascular disease and to determine if there are any clinical or laboratory differences between children with SCD with elevated periodic limb movement index (PLMI) versus those with normal PLMI. METHODS This study is a comprehensive review of medical records of 129 children with SCD (aged ≤ 18 years) who had undergone polysomnography for evaluation of sleep-disordered breathing. RESULTS Elevated PLMI (PLMI > 5 events/h) was present in 42% (54/129) of children with SCD. Children with elevated PLMI were found to have higher percentage of hemoglobin S, lower total iron, higher arousal index and tendency toward elevated transcranial Doppler velocity (P = .063, odds ratio = 3.9, 95% CI 0.93-16.22). While association between elevated PLMI and isolated cerebrovascular stenosis (P = .050, odds ratio 5.6, 95% CI 1.0-31.10) trended toward significance, there was significantly greater proportion of children with elevated PLMI who had cerebrovascular stenosis with Moyamoya disease (P = .046) as demonstrated by magnetic resonance imaging (MRI). CONCLUSIONS The prevalence of elevated PLMI in children with SCD was higher than in previously published data. Elevated PLMI was significantly associated with greater rates of cerebrovascular disease as detected by MRI.
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Affiliation(s)
- Jenny Lin
- Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Kerry Morrone
- Division of Pediatric Hematology and Oncology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Deepa Manwani
- Division of Pediatric Hematology and Oncology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Rina Chernin
- Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Ellen J Silver
- Division of Academic General Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Keivan Shifteh
- Division of Radiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Sanghun Sin
- Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Raanan Arens
- Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Katharina Graw-Panzer
- Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
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46
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Houwing ME, de Pagter PJ, van Beers EJ, Biemond BJ, Rettenbacher E, Rijneveld AW, Schols EM, Philipsen JNJ, Tamminga RYJ, van Draat KF, Nur E, Cnossen MH. Sickle cell disease: Clinical presentation and management of a global health challenge. Blood Rev 2019; 37:100580. [PMID: 31128863 DOI: 10.1016/j.blre.2019.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 01/12/2023]
Abstract
Sickle cell disease is an autosomal recessive, multisystem disorder, characterised by chronic haemolytic anaemia, painful episodes of vaso-occlusion, progressive organ failure and a reduced life expectancy. Sickle cell disease is the most common monogenetic disease, with millions affected worldwide. In well-resourced countries, comprehensive care programs have increased life expectancy of sickle cell disease patients, with almost all infants surviving into adulthood. Therapeutic options for sickle cell disease patients are however, still scarce. Predictors of sickle cell disease severity and a better understanding of pathophysiology and (epi)genetic modifiers are warranted and could lead to more precise management and treatment. This review provides an extensive summary of the pathophysiology and management of sickle cell disease and encompasses the characteristics, complications and current and future treatment options of the disease.
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Affiliation(s)
- M E Houwing
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - P J de Pagter
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E J van Beers
- Department of Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, Internal mail no C.01.412, 3508, GA, Utrecht, the Netherlands.
| | - B J Biemond
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - E Rettenbacher
- Department of Paediatric Haematology, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10, 6500, HB, Nijmegen, the Netherlands.
| | - A W Rijneveld
- Department of Haematology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E M Schols
- Department of Haematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - J N J Philipsen
- Department of Cell Biology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - R Y J Tamminga
- Department of Paediatric Oncology and Haematology, University Medical Center Groningen - Beatrix Children's Hospital, Postbus 30001, 9700, RB, Groningen, the Netherlands..
| | - K Fijn van Draat
- Department of Paediatric Haematology, Amsterdam University Medical Centers - Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Plasma Proteins, Sanquin Research, the Netherlands.
| | - E Nur
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
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Cahill CR, Leach JM, McClure LA, Irvin MR, Zakai NA, Naik R, Unverzagt F, Wadley VG, Hyacinth HI, Manly J, Judd SE, Winkler C, Cushman M. Sickle cell trait and risk of cognitive impairment in African-Americans: The REGARDS cohort. EClinicalMedicine 2019; 11:27-33. [PMID: 31312804 PMCID: PMC6610762 DOI: 10.1016/j.eclinm.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Sickle cell anemia may be associated with cognitive dysfunction, and some complications of sickle cell anemia might affect those with sickle cell trait (SCT), so we hypothesized that SCT is a risk factor for cognitive impairment. METHODS The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled a national cohort of 30,239 white and black Americans from 2003 to 7, who are followed every 6 months. Baseline and annual global cognitive function testing used the Six-Item Screener (SIS), a validated instrument (scores range 0-6; ≤ 4 indicates cognitive impairment). Participants with baseline cognitive impairment and whites were excluded. Logistic regression was used to calculate the association of SCT with incident cognitive impairment, adjusted for risk factors. Linear mixed models assessed multivariable-adjusted change in test scores on a biennially administered 3-test battery measuring learning, memory, and semantic and phonemic fluency. FINDINGS Among 7743 participants followed for a median of 7·1 years, 85 of 583 participants with SCT (14·6%) developed incident cognitive impairment compared to 902 of 7160 (12·6%) without SCT. In univariate analysis, the odds ratio (OR) of incident cognitive impairment was 1·18 (95% CI: 0·93, 1·51) for those with SCT vs. those without. Adjustment did not impact the OR. There was no difference in change on 3-test battery scores by SCT status (all p > 0·11). INTERPRETATION In this prospective cohort study of black Americans, SCT was not associated with incident cognitive impairment or decline in test scores of learning, memory and executive function. FUNDING National Institutes of Health, American Society of Hematology.
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Affiliation(s)
- Christina R. Cahill
- Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
| | - Justin M. Leach
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Leslie A. McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Marguerite Ryan Irvin
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
| | - Rakhi Naik
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Frederick Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Virginia G. Wadley
- Department of Medicine, Division of Gerontology Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Hyacinth I. Hyacinth
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Jennifer Manly
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Suzanne E. Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Cheryl Winkler
- Molecular Genetics Epidemiology Section, Frederick National Laboratory for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, United States of America
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, United States of America
- Corresponding author at: Department of Medicine, Larner College of Medicine at the University of Vermont, 360 South Park Drive, Colchester, VT 05446, United States of America.
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48
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Gai ND, Butman JA. Determining the optimal postlabeling delay for arterial spin labeling using subject-specific estimates of blood velocity in the carotid artery. J Magn Reson Imaging 2019; 50:951-960. [PMID: 30681220 DOI: 10.1002/jmri.26670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Arterial spin labeling with 3D acquisition requires determining a single postlabeling delay (PLD) value. PLD affects the signal-to-noise ratio (SNR) per unit time as well as quantitative cerebral blood flow (CBF) values due to its bearing on the presence of a vascular signal. PURPOSE To search for an optimal PLD for pseudocontinuous arterial spin labeling (pCASL) using patient-specific carotid artery blood velocity measurements. STUDY TYPE Prospective. SUBJECTS A control group of 11 volunteers with no known pathology. Corroboration was through a separate group of six volunteers and a noncontrol group of five sickle cell disease (SCD) patients. FIELD STRENGTH/SEQUENCE Pseudocontinuous arterial spin labeling with 3D nonsegmented echo planar imaging acquisition at 3T. ASSESSMENT A perfusion-based measure was determined over a range of PLDs for each of 11 volunteers. A third-order polynomial was used to find the optimal PLD where the defined measure was maximum. This was plotted against the corresponding carotid artery velocity to determine a relationship between the perfusion measure and velocity. Corroboration was done using a group of six volunteers and a noncontrol group of five patients with SCD. PLD was determined from the carotid artery velocity and derived relationship and compared with optimal PLD obtained from measured perfusion over a range of PLD values. Error between the perfusion measure at predicted and measured optimal PLD was determined. STATISTICAL TESTS Chi-squared goodness of fit; Pearson correlation; Bland-Altman. RESULTS Carotid artery velocity was 63.8 ± 6.6 cm/s (53.1 ≤ v ≤ 72.3 cm/s) while optimal PLD was 1374 ± 226.5 msec (1102 ≤ PLD ≤ 1787 msec) across the 11 volunteers. PLD as a function of carotid velocity was determined to be PLD = -31.94. v + 3410 msec (Pearson correlation -0.93). In six volunteers, mean error between the perfusion measure at predicted and measured optimal PLD was 1.35%. Pearson correlation between the perfusion measure at the predicted PLD and the measure obtained experimentally was r = 0.96 (P < 0.001). Bland-Altman revealed a slight bias of 1.3%. For the test case of five SCD patients, the mean error was 1.3%. DATA CONCLUSION Carotid artery velocity was used to determine optimal PLD for pCASL with 3D acquisition. The derived relationship was used to predict optimal PLD and the associated perfusion measure, which was found to be accurate when compared with its measured counterpart. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:951-960.
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Affiliation(s)
- Neville D Gai
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - John A Butman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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50
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Chatel B, Messonnier LA, Vilmen C, Bernard M, Pialoux V, Bendahan D. Ischaemia-induced muscle metabolic abnormalities are poorly alleviated by endurance training in a mouse model of sickle cell disease. Exp Physiol 2019; 104:398-406. [PMID: 30578584 DOI: 10.1113/ep087430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/17/2018] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? The aim of this study was to evaluate the potential beneficial effects of endurance training during an ischaemia-reperfusion protocol in a mouse model of sickle cell disease (SCD). What is the main finding and its importance? Endurance training did not reverse the metabolic defects induced by a simulated vaso-occlusive crisis in SCD mice, with regard to intramuscular acidosis, mitochondrial dysfunction or anatomical properties. Our results suggest that endurance training would reduce the number of vaso-occlusive crises rather than the complications related to vaso-occlusive crises. ABSTRACT The aim of this study was to investigate whether endurance training could limit the abnormalities described in a mouse model of sickle cell disease (SCD) in response to an ischaemia-reperfusion (I/R) protocol. Ten sedentary (HbSS-SED) and nine endurance-trained (HbSS-END) SCD mice were submitted to a standardized protocol of I/R of the leg, during which ATP, phosphocreatine and inorganic phosphate concentrations and intramuscular pH were measured using magnetic resonance spectroscopy. Forty-eight hours later, skeletal muscles were harvested. Oxidative stress markers were then measured. Although the time course of protons accumulation was slightly different between trained and sedentary mice (P < 0.05), the extent of acidosis was similar at the end of the ischaemic period. The initial rate of phosphocreatine resynthesis measured at blood flow restoration, illustrating mitochondrial function, was not altered in trained mice compared with sedentary mice. Although several oxidative stress markers were not different between groups (P > 0.05), the I/R-related increase of uric acid concentration observed in sedentary SCD mice (P < 0.05) was not present in the trained group. The spleen weight, generally used as a marker of the severity of the disease, was not different between groups (P > 0.05). In conclusion, endurance training did not limit the metabolic consequences of an I/R protocol in skeletal muscle of SCD mice, suggesting that the reduction in the severity of the disease previously demonstrated in the basal state would be attributable to a reduction of the occurrence of vaso-occlusive crises rather than a decrease of the deleterious effects of vaso-occlusive crises.
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Affiliation(s)
| | - Laurent A Messonnier
- Université Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-73000, Chambéry, France
| | | | | | - Vincent Pialoux
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Villeurbanne, France
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