Sickle cell disease induces resistance to cutaneous carcinogenesis

Cervical precancer screening with HPV DNA testing and mobile colposcopy in women with sickle cell disease in Accra, Ghana

Background

Worldwide, about 20-25 million people are affected by sickle cell disease (SCD), with 60% of patients living in sub-Saharan Africa. Despite recent therapeutic advancements resulting in improved life expectancy among SCD patients, the prevalence of high-risk human papillomavirus (hr-HPV) and cervical lesions have not been studied in women with SCD. We determined the prevalence of hr-HPV and cervical lesions among women with SCD and recommended strategies for reducing cervical cancer incidence in this cohort.

Methods

Through the mPharma 10,000 Women Initiative, women with SCD attending routine visits at the Ghana Institute of Clinical Genetics SCD clinic were screened by trained nurses. Screening was performed via concurrent MA-6000 hr-HPV DNA testing and enhanced visual assessment (EVA) mobile colposcopy from mobileODT.

Results

Among 168 participants screened (mean age, 43.0 years), the overall prevalence rates of hr-HPV infection and cervical lesions were 28.6% (95% CI, 21.7-35.4) and 3.6% (95% CI, 0.8-6.4), respectively. The hr-HPV prevalence rates stratified by haemoglobin genotype were 29.4% (95% CI, 19.7-39.1) and 28.6% (95% CI, 18.5-38.7) for genotypes SS and SC, respectively. None of the five women with the SF genotype tested hr-HPV positive, and the only patient with Sbthal genotype tested hr-HPV positive. Two women were EVA 'positive' but hr-HPV negative, whereas four were EVA positive and hr-HPV positive. Exploratory analysis revealed no significant associations between hr-HPV positivity and age, education level, marital status or parity.

Conclusion

In the absence of a comprehensive national cervical screening programme aimed at including women with SCD as a special population, cervical cancer may increase in frequency among SCD patients. Thus, there is a need to build capacity and expand the scope of screening services for women with SCD.

Cutaneous manifestations of sickle cell disease: an updated review

Sickle cell disease is a common and highly morbid genetic condition that is characterized by multi-system involvement, including numerous cutaneous manifestations. Persistent and recurrent leg ulceration has long been considered the dermatological hallmark of those with sickle cell disease, but there have been recent descriptions of associated infection with rare pathogens and episodes of liverdoid vasculopathy. Growing considerations for this population in the literature include cutaneous reactions to common treatments such as hydroxyurea and clinical management of the intersection between sickle cell disease and conditions like plaque psoriasis. Recent studies have also demonstrated an increased resistance to skin carcinogenesis for those with sickle cell disease through unclear mechanisms. However, though the body of knowledge regarding cutaneous manifestations and considerations of sickle cell disease is slowly expanding, it does not match the considerable disease and symptom burden faced by these patients. More research is needed to better delineate our understanding of these cutaneous manifestations of sickle cell disease to improve outcomes and further management.

Efficacy and toxicity of hydroxyurea in mast cell activation syndrome patients refractory to standard medical therapy: retrospective case series

Determine efficacy and adverse events (AEs) of hydroxyurea (HU) in mast cell activation syndrome (MCAS) patients who were refractory to standard medical therapy. An electronic chart review was performed to find MCAS patients who received HU in a MCAS medical practice. Diagnosis of MCAS was established on the basis of mast cell (MC) activation symptoms in ≥ 5 systems plus ≥ 1 abnormal MC mediators and/or ≥ 20 MC/high power field on duodenal biopsies. Medicines not providing significant clinical improvement prior to HU were tabulated. The following symptoms were evaluated by patients on a 0–10 scale prior to and at the study conclusion: bone pain, abdominal pain, diarrhea, bloating, and nausea. Safety labs were obtained on a regular basis. Twenty out of three hundred ten (8.4%) MCAS patients received HU. Patients included 22 females, average age 42.4 years. Dysautonomia was present in 60%. An average of 10.6 (SD 1.7, range 8–13) medications were used prior to adding HU to various concomitant medications. Average dose of HU was 634 mg. In 20 patients who continued therapy for ≥ 2 months, there was statistically significant reduction of bone pain, abdominal pain, diarrhea, bloating, and nausea. Fourteen patients noted prolonged success with therapy. Six patients stopped HU within 6 weeks owing to AEs. Four patients treated ≥ 2 months had AEs and 2 led to HU cessation. All AEs were reversible. Refractory MCAS patients showed clear significant improvement in bone pain and gastrointestinal symptoms on HU. Systematic monitoring was effective in preventing the occurrence of severe HU-induced adverse events.

Prevalence and Predictive Factors for Leg Ulcers in Sickle Cell Disease Patients in Saudi Arabia: A Cross-Sectional Observational Study

Introduction

Saudi Arabia has a high prevalence of sickle cell disease (SCD). Leg ulceration is one of the complications associated with SCD. There is a gap in the literature in regard to the prevalence of leg ulcers among SCD patients in Saudi Arabia.

Objectives

The primary objective of this study was to evaluate the lifetime prevalence of leg ulcers in SCD patients in our population and to study the predictive factors of leg ulcers by using sociodemographic factors, clinical manifestations of SCD, and other relevant factors like hydroxyurea.

Methods

A cross-sectional study design was utilized. Data collection was done using an electronic survey to collect self-reported information for the prevalence of leg ulcers and possible associated factors. The survey was distributed using social media platforms. Chi-square test was used to test for the presence of an association between having leg ulcers and sociodemographic variables as well as SCD related history. Furthermore, binary logistic regression was utilized to determine factors predicting the incidence of leg ulcers among SCD.

Results

A total of 790 valid responses were included in the study. Among these, 646 were included in the analysis of leg ulcers prevalence. From them, 52 (8%) SCD patients reported a history of leg ulcers. The male to female ratio was (9.7% vs 7.2%). The age group most affected by leg ulcers was those older than 50 (16.7%). There was no significant association between a history of leg ulcers and sociodemographic variables. The only predictive factors for leg ulcers were having six to eight vaso-occlusive crises per month and having more than eight vaso-occlusive crises per month.

Conclusion

Leg ulcers among SCD patients in Saudi Arabia were considerably prevalent (8%). There was no statistically significant correlation between leg ulceration and sociodemographic variables. Leg ulcers were more likely in patients with a history of highly frequent vaso-occlusive crises. No association was found between the incidence of leg ulcers and other complications of sickle cell disease or hydroxyurea.