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Hamed NF, Alatawi YDA, AlKabbani DMZ. Prevalence, Risk Factors, and Complications of Sickle Cell Disease in Saudi Arabia: A Systematic Review. Cureus 2024; 16:e65263. [PMID: 39184654 PMCID: PMC11342824 DOI: 10.7759/cureus.65263] [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: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
This study examined sickle cell disease (SCD) in Saudi Arabia. A systematic search of relevant databases was conducted to identify studies investigating SCD in the Saudi population. Studies were then screened based on predefined criteria and critically appraised for methodological quality. Data was extracted and synthesized to provide an overall picture of the SCD burden in Saudi Arabia. The most commonly reported complications were vaso-occlusive crises (VOC), acute chest syndrome (ACS), acute painful crisis, splenic sequestration, osteomyelitis, aplastic crisis, hemolytic crisis, serious bacterial infections, chronic vascular occlusion (CVO), depression, sickle cell nephropathy (SCN), obstructive sleep apnea (OSA), and renal complications. Reduced blood levels of antioxidant trace elements (Cu, Zn, and Se) may encourage oxidative stress, which in turn may contribute to the pathophysiology of SCD. Infections and ACS were common among young children (<7 years) while pain attacks were common in older children (>7 years). The high rate of hospitalizations among SCD patients highlights the need for better management strategies. Future research should focus on understanding the underlying causes of SCD complications and developing new ways to control them.
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Affiliation(s)
- Nazim F Hamed
- General Pediatrics, Maternity and Children Hospital, Tabuk, SAU
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2
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Wasnik P, Das P, Kumar A, Kannauje PK, R R, Pandit V, Sahu T, Sahu J. Hospitalization Events Among Adolescents and Adults With Sickle Cell Disease in a Tertiary Care Center in Central India. Cureus 2024; 16:e61185. [PMID: 38933640 PMCID: PMC11200316 DOI: 10.7759/cureus.61185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited red blood cell disorder, wherein mutation causes the substitution of glutamic acid to valine at the sixth position of the β-globin chain. These include sickle cell anemia (homozygous sickle mutation), sickle-beta thalassemia, and hemoglobin SCD. The clinical manifestations of SCD are protean. Individuals with SCD suffer from both acute and chronic complications, which include recurring episodes of pain commonly called vaso-occlusive crisis (VOC) - acute chest syndrome (ACS); aseptic necrosis of the bone; micro-infarction of the spleen, brain, and kidney; infections; stroke; and organ damage affecting every part of the body. SCD necessitates frequent hospitalizations because of severe complications, which pose a significant burden on caregivers and economic strain on healthcare systems. The pattern of hospital admission with SCD varies in different parts of the world. OBJECTIVE This study aimed to determine the causes of hospitalization among adolescent and adult patients with SCD and to determine factors associated with their hospital stay. METHODS The study was a hospital-based prospective observational study comprising adolescent and adult patients diagnosed with SCD, aged 15-45 years, who were hospitalized in the Department of General Medicine at All India Institute of Medical Sciences in Raipur from August 2021 to August 2022. RESULT According to our study, the primary reason for hospitalization was a painful crisis, accounting for 63% of cases, followed by infection (17%), ACS (11%), and acute hemolytic crisis (9%). Notably, we did not observe any significant differences between genders and causes of admission (p > 0.05). Joint pain (p = 0.005), back pain (p = 0.001), and chest pain (p = 0.001) were more frequently reported by adults over the age of 19. In addition, our analysis of the duration of hospital stays and various factors revealed that patients admitted for infections had a significantly longer mean hospital stay duration (p = 0.040). CONCLUSION Acute painful crises were the primary cause of hospital admission among individuals with SCD; many patients also encountered infections and ACS. Furthermore, patients who experienced infections and VOC had a lengthier duration of hospital stay. Therefore, it is essential to provide them with comprehensive instructions on various preventive measures against infections and the factors that trigger painful crises.
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Affiliation(s)
- Preetam Wasnik
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Pranita Das
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Ajit Kumar
- General Medicine, Shri Balaji Institute of Medical Science, Raipur, IND
| | - Pankaj K Kannauje
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Rohini R
- Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Vinay Pandit
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Tarun Sahu
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Jyoti Sahu
- General Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Jerman H, Chang YS. Sickle cell disease: healthcare professionals' views of patients in the emergency department. Emerg Nurse 2024; 32:22-27. [PMID: 37580998 DOI: 10.7748/en.2023.e2171] [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] [Accepted: 05/26/2023] [Indexed: 08/16/2023]
Abstract
Most patients with sickle cell disease (SCD) need support from healthcare services to manage their condition, including painful vaso-occlusive crises. Vaso-occlusive crises should be treated as a medical emergency, but the quality of the care patients receive when they present to the emergency department (ED) is often suboptimal. This article reports the findings of a literature review on the views of ED nurses and doctors about patients with SCD. The review included four studies, all of which had been conducted in the US, demonstrating that research on the topic is limited. The review found mostly negative views, including the belief that patients misuse pain medicines and demonstrate drug-seeking behaviours. Racial bias, widely recognised as a negative influence on the care of patients with SCD, was not mentioned in any of the studies. Staff education regarding SCD is required to ensure patients receive the care they need when they present to the ED.
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Affiliation(s)
- Hannah Jerman
- Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, England
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Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Risk factors for acute chest syndrome among children with sickle cell anemia hospitalized for vaso-occlusive crises. Sci Rep 2024; 14:5978. [PMID: 38472301 DOI: 10.1038/s41598-023-48527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 03/14/2024] Open
Abstract
Sickle cell anemia (SCA) is a globally prevalent inherited condition, with acute chest syndrome (ACS) being one of its most severe complications. ACS frequently leads to hospitalization, requires intensive care unit (ICU) admission, and can even result in death. This study aimed to discern the early indicators of impending ACS in children with SCA who were initially hospitalized due to painful vaso-occlusive crises (VOC). This was a retrospective, case‒control investigation of 120 patients aged 1-14 years seen at the King Saud Medical City in Riyadh, Saudi Arabia from January 2021 to December 2022. Patients were classified into cases and controls: those who developed and did not develop ACS during hospital stay, respectively. Demographic factors, laboratory results, vital and clinical signs, and treatment protocols were compared between these groups. The following were significant predictors of impending ACS: previous diagnosis of asthma, history of ACS, recent upper respiratory tract symptoms prior to admission, and need for a blood transfusion within the first 24 h of admission due to a drop in hemoglobin levels. Further regression analysis indicated that elevated steady-state mean corpuscular volume, leukocyte count, total bilirubin, and an increased absolute neutrophil count level 24 h after admission also foreshadowed impending ACS among patients admitted for VOC. The location of pain was also significant; the incidence of ACS was higher in patients with back pain, but lower in those with pain confined to the limbs. The ACS group had a longer average duration of hospital stay compared to those with VOC alone, (7.6 vs. 5.8 days). Among patients initially admitted for VOC, 15.7% were diagnosed with ACS. Most ACS cases were managed with transfusions and antibiotics, and nearly one-third of patients needed admission to an ICU or a high-dependency area.
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Affiliation(s)
- Faisal A Alghamdi
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Fawaz Al-Kasim
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Forat Alshhada
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
- Medical Specialized Center, Riyadh, Saudi Arabia
| | - Eatedal Ghareeb
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fauzia R Azmet
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adel Almudaibigh
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Lobna Baitalmal
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bedah Alnawfal
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rehab Alluqmani
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
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5
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Charlotte EE, Edgar MML, Yolande PD, Daniele-Christiane KMK, Betoko MR, Patricia E, Iyawa H, Ngenge MB, Abigaelle M, Diomède NN, Dominique E, Gaelle NK, Juliana J, Karen E, Georgette MEJ, Margaret EM, Doriane E, Penda CI. Comparison of in-hospital mortality in children and adolescents with sickle cell disease in a resource-limited setting before and during the COVID-19 pandemic. Arch Pediatr 2024; 31:38-43. [PMID: 37989661 DOI: 10.1016/j.arcped.2023.10.001] [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: 09/29/2022] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND COVID-19 in children and adolescents with sickle cell disease (SCD) has variable presentations (from mild to severe disease), and the main symptoms are vaso-occlusive crises (VOC) and acute chest syndrome (ACS). We hypothesized that the desertion of hospitals due to the pandemic would lead to late arrival at the emergency room and an increased mortality. In this study, we sought to measure and compare the mortality of children with sickle cell disease before and during the COVID-19 pandemic. MATERIAL AND METHODS We conducted a retrospective cohort study at the sickle cell disease management center of Laquintinie Hospital in Douala (Cameroon). The study period was divided into two, i.e., from March 2019 to February 2020 (Pre-COVID-19) and from March 2020 to February 2021 (COVID-19). All administrative and ethical considerations were fully respected. Data were analyzed using SPSS 20.0. RESULTS Overall, 823 patients were admitted during the study period. Males represented 52.4% of the overall population, giving a sex ratio of 1.1:1. We admitted 479 patients during the pre-COVID-19 period versus 344 patients during the COVID-19 period, which is a 28.2% drop in admissions during the COVID-19 period. The mortality rate was 3.5% during the pre-COVID-19 period and 3.2% during the COVID-19 period (p>0.05). The most common causes of death were ACS (39.3%, n = 11), severe anemia (25.0%, n = 7), and VOC (17.9%, n = 5). ACS (adjusted odds ratio [aOR]=3.628, 95% confidence interval [CI], [1.645-7.005], p<0.001) was significantly associated with mortality. CONCLUSION During the COVID-19 pandemic, although the consultation frequency decreased, the mortality rate of sickle cell disease patients remained unchanged.
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Affiliation(s)
- Eposse Ekoube Charlotte
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | - Mandeng Ma Linwa Edgar
- Laquintinie Hospital of Douala, Douala, Cameroon; Faculty of Health Sciences, University of Buea, Buea, Cameroon.
| | | | | | - Mbono Ritha Betoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | - Epee Patricia
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Hassanatou Iyawa
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | | | - Megoze Abigaelle
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Noukeu Njinkui Diomède
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Enyama Dominique
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | | | - Ekotto Karen
- Laquintinie Hospital of Douala, Douala, Cameroon
| | | | | | - Ekoe Doriane
- Laquintinie Hospital of Douala, Douala, Cameroon
| | - Calixte Ida Penda
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Sendy JS, Alsadun MS, Alamer SS, Alazzam SM, Alqurashi MM, Almudaibigh AH. Frequency of Painful Crisis and Other Associated Complications of Sickle Cell Anemia Among Children. Cureus 2023; 15:e48115. [PMID: 38046719 PMCID: PMC10691739 DOI: 10.7759/cureus.48115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Background Sickle cell disease (SCD) represents a group of inherited health conditions that affect red blood cells. SCD is a relatively common genetic disorder in Saudi Arabia, with the highest prevalence found in the Eastern Province region. The most common complications of SCD include acute chest syndrome, vaso-occlusive crisis, stroke, and avascular necrosis of the femoral head. The disease itself is not a cause of mortality but systemic complications are. Methodology In this retrospective study, we aimed to determine the frequency of painful crisis and the associated complications of sickle cell anemia (SCA) among children at King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. Results This study included a total of 70 children with SCA below the age of 14 years who were admitted to KSMC from January 2021 to December 2021. Overall, 60% of the participants had one painful crisis attack per year, whereas 27% had two attacks. Furthermore, 94% of the participants were being treated with hydroxyurea. The most frequent cause of admission was painful crises with acute chest syndrome. Conclusions This study highlights the frequency of hydroxyurea use among SCA patients. Our results showed that participants who developed one to two painful crises per year were hospitalized for four to nine days on average with increased utilization of hydroxyurea.
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Affiliation(s)
- Jana S Sendy
- College of Medicine, Almaarefa University, Riyadh, SAU
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7
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Oppong–Mensah YG, Odoom SF, Nyanor I, Amuzu EX, Yawnumah SA, Asafo‐Adjei E, Nguah SB, Ansong D, Osei‐Akoto A, Paintsil V. Hospitalizations among children with sickle cell disease enrolled in the Kumasi Sickle Cell Pan African Consortium (SPARCo) database: A cross sectional study. Health Sci Rep 2023; 6:e1534. [PMID: 37670846 PMCID: PMC10475768 DOI: 10.1002/hsr2.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/15/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Background and Aims Sickle cell disease (SCD) is the commonest monogenic haemolytic disorder in Africa. Despite strides made in its management, a significant proportion of patients are hospitalized from the various complications of the disease. This study set out to describe the main causes and outcomes of hospitalizations among pediatric patients with SCD. Methods A cross-sectional study was conducted at the Pediatric Emergency Unit of Komfo Anokye Teaching Hospital within a period of 12 months to recruit pediatric SCD patients. This study looked at causes of admission, length of hospital stay (LOS), and outcome of admission. Results Of the 201 SCD patients recruited, 57.2% were males and majority were of SCD-SS phenotype 83.1%. The median age was 6 years. The three leading causes of hospitalization were Vaso-occlusive pain events (VOPE) (39.8%), acute chest syndrome (ACS) (25.9%), and infections (12.4%). Ten (5.0%) of the patients presented with a stroke. High admissions were observed in June (12.4%) and November (16.9%). The median (interquartile range [IQR]) LOS was 6 days (IQR: 4-10). Six (3.0%) of the patients died from complications of the disease during hospitalization. Conclusion VOPE, ACS, infections, and acute anaemia from hyperhaemolysis were observed as the most common causes of admissions among SCD patients. A good outcome of discharge was seen in most of the patients that were hospitalized with a median length of stay of 6 days. This study also strengthens the importance of a good SCD database with patient follow-ups for better outcomes in SCD patients.
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Affiliation(s)
| | | | - Isaac Nyanor
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
| | | | | | | | - Samuel Blay Nguah
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Daniel Ansong
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Alex Osei‐Akoto
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Vivian Paintsil
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
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8
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Ahmed K, Abdu Y, Khasawneh S, Shukri A, Adam E, Mustafa S, Affas M, Mohamed Ibrahim MI, Al Zayed A, Yassin MA. The effect of intermittent fasting on the clinical and hematological parameters of patients with sickle cell disease: A preliminary study. Front Med (Lausanne) 2023; 10:1097466. [PMID: 36895718 PMCID: PMC9989014 DOI: 10.3389/fmed.2023.1097466] [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: 11/13/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Sickle cell disease is a genetic disorder that frequently presents with vaso-occlusive crisis (VOC). Most patients with sickle cell disease in Qatar are Muslims; hence, they practice intermittent fasting during the holy month of Ramadan. However, there is a paucity of literature describing the effect of intermittent fasting on the occurrence of severe VOC. As a result, there is a lack of guidelines or standardized protocols that can help physicians advise patients with sickle cell disease who wish to practice intermittent fasting. Therefore, this study's aim was to investigate the effect of intermittent fasting on the clinical and hematological parameters of individuals with sickle cell disease. Methods We conducted a retrospective study for 52 Muslim patients with sickle cell disease in Qatar aged ≥18 years who were confirmed to be fasting during the holy month of Ramadan during any of the years 2019-2021. The difference in the occurrence of severe VOC, hemolytic crisis, and other clinical, hematological, and metabolic parameters were studied one month before, during, and one month after the intermittent fasting of Ramadan using the patient's medical records. Mean (sd), median (IQR), and frequency (%) described the data. One-way with repeated measures ANOVA with a Greenhouse-Geisser correction and Friedman tests (*) were used at alpha level 0.05. Results The study participants' (mean±sd) age was (31.1±9.2) years, 51.9% were males, and 48.1% were females. Roughly seventy percent of the participants were of Arab ethnicity, while the rest were either African or Asian. Most of the patients were homozygotes (SS) (90.4%). The median number of severe VOC (P = 0.7) and hemolytic crisis (P = 0.5) was not found to be significantly different before, during, or after Ramadan. Significant differences, however, were found in platelet count (P = 0.003), reticulocyte count (P < 0.001), and creatinine level (P = 0.038) with intermittent fasting. Discussion In this preliminary study, intermittent fasting does not seem to influence the rate of occurrence of severe vaso-occlusive crisis or hemolytic crisis in patients with sickle cell disease; however, it was found to be associated with differences in platelet count, reticulocytes count, and creatinine level. The statistical and clinical significance of these findings needs to be confirmed in studies with a larger sample size.
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Affiliation(s)
- Khalid Ahmed
- Department of Hematology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Yasamin Abdu
- Department of Community Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sief Khasawneh
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ahmed Shukri
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ehab Adam
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Salma Mustafa
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohammad Affas
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
| | | | | | - Mohamed A Yassin
- Department of Hematology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
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Jones NM, Sysol JR, Singla S, Smith P, Sandusky GE, Wang H, Natarajan V, Dudek SM, Machado RF. Cortactin loss protects against hemin-induced acute lung injury in sickle cell disease. Am J Physiol Lung Cell Mol Physiol 2022; 322:L890-L897. [PMID: 35503995 PMCID: PMC9169831 DOI: 10.1152/ajplung.00274.2021] [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: 06/30/2021] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
In patients with sickle cell disease (SCD), acute chest syndrome (ACS) is a common form of acute lung injury and a major cause of morbidity and mortality. The pathophysiology of ACS is complex, and hemin, the prosthetic moiety of hemoglobin, has been implicated in endothelial cell (EC) activation and subsequent acute lung injury (ALI) and ACS in vitro and in animal studies. Here, we examined the role of cortactin (CTTN), a cytoskeletal protein that regulates EC function, in response to hemin-induced ALI and ACS. Cortactin heterozygous (Cttn+/-) mice (n = 8) and their wild-type siblings (n = 8) were irradiated and subsequently received bone marrow cells (BMCs) extruded from the femurs of SCD mice (SS) to generate SS Cttn+/- and SS CttnWT chimeras. Following hemoglobin electrophoretic proof of BMC transplantation, the mice received 35 µmol/kg of hemin. Within 24 h, surviving mice were euthanized, and bronchoalveolar fluid (BAL) and lung samples were analyzed. For in vitro studies, human lung microvascular endothelial cells (HLMVECs) were used to determine hemin-induced changes in gene expression and reactive oxygen species (ROS) generation in cortactin deficiency and control conditions. When compared with wild-type littermates, the mortality for SS Cttn+/- mice trended to be lower after hemin infusion and these mice exhibited less severe lung injury and less necroptotic cell death. In vitro studies confirmed that cortactin deficiency is protective against hemin-induced injury in HMLVECs, by decreasing protein expression of p38/HSP27, improving cell barrier function, and decreasing the production of ROS. Further studies examining the role of CTTN in ACS are warranted and may open a new avenue of potential treatment for this devastating disease.
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Affiliation(s)
- Nicole M Jones
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Justin R Sysol
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Sunit Singla
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Patricia Smith
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - George E Sandusky
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Huashan Wang
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Viswanathan Natarajan
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Department of Pharmacology & Regenerative Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Steven M Dudek
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Roberto F Machado
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Zakaria OM, Buhalim RA, Al Jabr FA, AlSaeed MN, Al-Hajji IA, Al Saleh YA, Buhalim MA, Al Dehailan AM. Reasons for Hospitalization of Sickle Cell Disease Patients in the Eastern Province of Saudi Arabia: A Single-Center Study. Cureus 2021; 13:e19299. [PMID: 34900476 PMCID: PMC8649982 DOI: 10.7759/cureus.19299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Sickle cell disease (SCD) is among the prevalent chronic diseases in the Eastern Province of Saudi Arabia. To our knowledge, there is no published research that reports the reasons for hospitalization in the Eastern Province of the country. Therefore, this study aimed to fill this gap. Design and methods: This is a retrospective cohort study that was conducted in the period from January 2018 to December 2019. Patients with sickle cell disease who were admitted and treated in the hospital were included in this study. Patients’ sociodemographic data and reasons for hospitalization were collected and analyzed using the statistical package for social sciences, version 21 (SPSS, Chicago, IL, USA). Results: There were 103 SCD patients, and the age range was from 18 to 62 years old. The majority of the patients were males (56.3%) and were in the younger age group (≤30 years old; 60.2%). The results showed that the most frequent cause of admission was a vaso-occlusive crisis (VOC) (n=94, 91.3%), followed by acute chest syndrome (ACS) (n=32, 31.1%), and then by hemolytic crisis (27 of the cases; 26.2%). However, we found that a higher number of hip avascular necrosis (AVN) cases were statistically significant in relation to the higher number of hospital admissions (p<0.05), whereas other reasons were not found to have a statistically significant association. Conclusion: The most frequent cause of admission was VOC episodes, followed by ACS, and then by hemolytic crises. Also, a higher number of hip AVN episodes were statistically significant with the higher number of hospital admissions.
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Affiliation(s)
- Ossama M Zakaria
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, SAU
| | - Rayan A Buhalim
- Department of Medicine, College of Medicine, King Faisal University, Al-Ahsa, SAU
| | - Faisal A Al Jabr
- Department of Medicine, College of Medicine, King Faisal University, Al-Ahsa, SAU
| | - Mohammed N AlSaeed
- Department of Medicine, College of Medicine, King Faisal University, Al-Ahsa, SAU
| | - Ibrahim A Al-Hajji
- Department of Medicine, College of Medicine, King Faisal University, Al-Ahsa, SAU
| | - Yousif A Al Saleh
- Department of Medicine, College of Medicine, King Faisal University, Al-Ahsa, SAU
| | - Mohammed A Buhalim
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, SAU
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Abd El-Ghany SM, Tabbakh AT, Nur KI, Abdelrahman RY, Etarji SM, Almuzaini BY. Analysis of Causes of Hospitalization Among Children with Sickle Cell Disease in a Group of Private Hospitals in Jeddah, Saudi Arabia. J Blood Med 2021; 12:733-740. [PMID: 34408522 PMCID: PMC8364845 DOI: 10.2147/jbm.s318824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Sickle cell anemia (SCA) is a chronic hematologic condition that requires frequent hospitalization representing a significant economic burden on the health services. The aim of this study was to explore the causes and underlying factors of hospitalization among children with SCA, as well as the factors affecting their length of hospital stay. Patients and Methods This retrospective study included children and adolescents less than 16 years old who were admitted in a group of private hospitals in Jeddah, Saudi Arabia, during the period from January 2018 to December 2019. Results A total of 94 patients were included in this study, 59.6% were males, with a mean age 7.29 ± 3.82 years. The majority of the patients (91.5%) had sickle cell disease. The most common cause of hospital admission was vaso-occlusive crises (VOC) (64.9%) followed by infection (24.5%), acute chest syndrome (ACS) (18.1%), and acute hemolytic crisis (12.8%). We found no significant difference between gender and different causes of admissions (p > 0.05). While in relation to age group, limb pain and back pain were found to be significantly more frequent among children ≥ 7 years old (p = 0.03,0.04), while infections were significantly more frequent among children < 7 years old (p = 0.003). We analyzed the length of hospital stay and different factors, and we found that the mean length of hospital stay was significantly higher among children who were admitted with infections (p = 0.01) and ACS (p < 0.001) and among children who are non-compliant on hydroxyurea (p = 0.04). Conclusion The most common cause of hospitalization among children with SCD in Jeddah, Saudi Arabia, was VOC followed by infection, ACS and acute anemia. The length of hospital stay was more prolonged among children with infection and ACS, as well as children who were non-compliant to hydroxyurea.
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Affiliation(s)
- Shereen M Abd El-Ghany
- Department of Pediatrics, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia.,Department of Pediatrics, Hematology and Oncology Unit, Ain Shams University, Cairo, Egypt
| | - Aisha T Tabbakh
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Khulud I Nur
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Rayan Y Abdelrahman
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Sara M Etarji
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Bayan Y Almuzaini
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
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Hejazi RA, Mandourah NA, Alsulami AS, Bakhsh HT, Diri RM, Noor AO. Commonly used agent for acute pain management of sickle cell anemia in Saudi Emergency Department: A narrative review. Saudi Pharm J 2021; 29:487-496. [PMID: 34194255 PMCID: PMC8233527 DOI: 10.1016/j.jsps.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Sickle-cell disease (SCD) is one of the most common hematologic inherited disorders in Saudi Arabia. Vaso-occlusive pain crisis in SCD is a major cause for emergency visits and patients' pain may be undertreated. This study presents a narrative literature review of current agents used to manage acute pain crisis in SCD patients presenting to the emergency department in hospitals of Saudi Arabia. METHOD We conducted a narrative review on relevant published articles about sickle cell disease pain crisis management in Saudi Arabia and included seven relevant studies based on our inclusion criteria. RESULTS Using our search strategy, we included 7 studies Out of 4052. Studies included were conducted in different locations in the country. Four studies were in the Eastern region while only one in Western and One in Central regions. Those studies included around 2441 patients, in total. Morphine was used in 5 studies out of the 7 included. Pethidine was used in 4. One study used Isoxsuprine and another study used tinzaparin. CONCLUSION We found that continuous administration of IV morphine accompanied by oral analgesics including NSAIDs and acetaminophen is the most commonly used practice for treating SCD patients presenting with a vaso-occlusive pain crisis. Possible effectiveness of tinzaparin, isoxsuprine, and pethidine as therapeutic options may be considered. However, there was no recommendation for a certain agent to be prescribed. We recommend conducting further clinical randomized-controlled trials.
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Affiliation(s)
| | | | | | - Hussain T. Bakhsh
- Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem M. Diri
- Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad O. Noor
- Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
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Wali Y, Kini V, Yassin MA. Distribution of sickle cell disease and assessment of risk factors based on transcranial Doppler values in the Gulf region. ACTA ACUST UNITED AC 2020; 25:55-62. [PMID: 31983291 DOI: 10.1080/16078454.2020.1714113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background/Objective: Stroke is a potentially fatal complication of sickle cell disease (SCD). Transcranial Doppler (TCD) is useful at identifying increased risk of stroke in children with SCD and vasospasm after subarachnoid hemorrhage. The main aim of this study was to determine the proportion of patients with SCD in the Gulf region who are at a high risk of stroke, as determined by TCD.Methods: This multicenter (Oman, Qatar, and UAE), descriptive, cross-sectional study in patients (aged 2-16 years) with SCD included a baseline visit, 1 follow-up visit for patients with conditional TCD, and 3-year retrospective data analysis for all patients.Results: Of the 410 eligible patients (Oman, 86.5%; Qatar, 8.2%; UAE, 5.1%), most had a TCD finding (left side, 91.7%; right side, 92.0%) of normal velocity (<155 cm/s) at baseline. For 6 of 7 patients with conditional velocity (155-179 cm/s) and 1 patient with high velocity (≥180 cm/s), baseline TCD results were not confirmed at follow-up. As per bivariate linear regression, age, race, transfusion type, and transfusion frequency were significant predictors of the TCD velocities. Multivariate logistic regressions revealed that TCD velocities were significantly correlated with sex, race, and type of transfusion. No patients reported any adverse events at follow-up. No deaths occurred during the study.Discussion/Conclusions: The study results show that far fewer patients with SCD in the Gulf have abnormal TCD findings than the internationally reported. Larger studies are needed to identify the factors underlying this observation.
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Affiliation(s)
- Yasser Wali
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman.,Alexandria University Children's Hospital, Alexandria, Egypt
| | | | - Mohamed A Yassin
- Department of Medicine, College of Medicine, Qatar University, Doha, Qatar
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Olupot-Olupot P, Wabwire H, Ndila C, Adong R, Ochen L, Amorut D, Abongo G, Okalebo CB, Akello SR, Oketcho JB, Okiror W, Asio S, Odiit A, Alaroker F, Nyutu G, Maitland K, Williams TN. Characterising demographics, knowledge, practices and clinical care among patients attending sickle cell disease clinics in Eastern Uganda. Wellcome Open Res 2020; 5:87. [PMID: 32802962 PMCID: PMC7406951 DOI: 10.12688/wellcomeopenres.15847.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background: In Uganda to date, there are neither established registries nor descriptions of facility-based sickle cell disease (SCD) patient characteristics beyond the central region. Here, we summarize data on the baseline clinical characteristics and routine care available to patients at four clinics in Eastern Uganda as a prelude to a clinical trial. Methods: Between February and August 2018, we conducted a cross-sectional survey of patients attending four SCD clinics in Mbale, Soroti, Atutur and Ngora, all in Eastern Uganda, the planned sites for an upcoming clinical trial (H-PRIME: ISRCTN15724013). Data on socio-demographic characteristics, diagnostic methods, clinic schedules, the use of prophylactic and therapeutic drugs, clinical complications and patient understanding of SCD were collected using a structured questionnaire. Results: Data were collected on 1829 patients. Their ages ranged from 0 to 64 years with a median (IQR) of 6 (3-11) years. 49.1% of participants were male. The majority (1151; 62.9%) reported a positive family history for SCD. Approximately half knew that SCD is inherited from both parents but a substantial proportion did not know how SCD is transmitted and small numbers believed that it is acquired by either transfusion or from other people. Only 118/1819 (6.5%) participants had heard about or were using hydroxyurea while 356/1794 (19.8%) reported stigmatization. Participants reported a median of three (IQR 1-4) hospital admissions during the preceding 12 months; 80.8% had been admitted at least once, while 14.2% had been admitted more than five times. Pain was the most common symptom, while 83.9% of those admitted had received at least one blood transfusion. Conclusion: The majority of patients attending SCD clinics in Eastern Uganda are children and few are currently being treated with hydroxyurea. The data collected through this facility-based survey will provide background data that will be useful in planning for the H-PRIME trial.
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Affiliation(s)
- Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ham Wabwire
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | - Ruth Adong
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Linus Ochen
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Denis Amorut
- Mbale Clinical Research Institute, Mbale, Uganda
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - Grace Abongo
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | | | | | | | - Sarah Asio
- Atutur District Hospital, Atutur, Uganda
| | - Amos Odiit
- Ngora Freda Carr Hospital, Ngora, Uganda
| | | | - Gideon Nyutu
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kathryn Maitland
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College London, London, UK
| | - Thomas N. Williams
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College London, London, UK
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Olupot-Olupot P, Wabwire H, Ndila C, Adong R, Ochen L, Amorut D, Abongo G, Okalebo CB, Akello SR, Oketcho JB, Okiror W, Asio S, Odiit A, Alaroker F, Nyutu G, Maitland K, Williams TN. Characterising demographics, knowledge, practices and clinical care among patients attending sickle cell disease clinics in Eastern Uganda. Wellcome Open Res 2020; 5:87. [PMID: 32802962 PMCID: PMC7406951 DOI: 10.12688/wellcomeopenres.15847.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 03/30/2024] Open
Abstract
Background: In Uganda to date, there are neither established registries nor descriptions of facility-based sickle cell disease (SCD) patient characteristics beyond the central region. Here, we summarize data on the baseline clinical characteristics and routine care available to patients at four clinics in Eastern Uganda as a prelude to a clinical trial. Methods: Between February and August 2018, we conducted a cross-sectional survey of patients attending four SCD clinics in Mbale, Soroti, Atutur and Ngora, all in Eastern Uganda, the planned sites for an upcoming clinical trial (H-PRIME: ISRCTN15724013). Data on socio-demographic characteristics, diagnostic methods, clinic schedules, the use of prophylactic and therapeutic drugs, clinical complications and patient understanding of SCD were collected using a structured questionnaire. Results: Data were collected on 1829 patients. Their ages ranged from 0 to 64 years with a median (IQR) of 6 (3-11) years. 50.9% of participants were male. The majority (1151; 62.9%) reported a positive family history for SCD. Approximately half knew that SCD is inherited from both parents but a substantial proportion did not know how SCD is transmitted and small numbers believed that it is acquired by either transfusion or from other people. Only 118/1819 (6.5%) participants had heard about or were using hydroxyurea while 356/1794 (19.8%) reported stigmatization. Participants reported a median of three (IQR 1-4) hospital admissions during the preceding 12 months; 80.8% had been admitted at least once, while 14.2% had been admitted more than five times. Pain was the most common symptom, while 83.9% of those admitted had received at least one blood transfusion. Conclusion: The majority of patients attending SCD clinics in Eastern Uganda are children and few are currently being treated with hydroxyurea. The data collected through this facility-based survey will provide background data that will be useful in planning for the H-PRIME trial.
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Affiliation(s)
- Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ham Wabwire
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | - Ruth Adong
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Linus Ochen
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Denis Amorut
- Mbale Clinical Research Institute, Mbale, Uganda
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - Grace Abongo
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | | | | | | | - Sarah Asio
- Atutur District Hospital, Atutur, Uganda
| | - Amos Odiit
- Ngora Freda Carr Hospital, Ngora, Uganda
| | | | - Gideon Nyutu
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kathryn Maitland
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College London, London, UK
| | - Thomas N. Williams
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College London, London, UK
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