The role of hydroxyurea in decreasing the occurrence of vasso-occulusive crisis in pediatric patients with sickle cell disease at King Saud Medical City in Riyadh, Saudi Arabia

Frequency of Painful Crisis and Other Associated Complications of Sickle Cell Anemia Among Children

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.

Design and Development of Fe3O4@Prussian Blue Nanocomposite: Potential Application in the Detoxification of Bilirubin

BACKGROUND

Prussian blue nanoparticles (PBNPs) due to their high solubility, stability, flexible molecular structure, tunable size, easy synthesis, and surface modification have attracted the attention of researchers as high-efficiency therapeutic agents. Recently, it has been reported that magnetic nanoparticles can be to bind pathogenic substances on their surface, followed by a recollection by magnetic separation. Considering the potential application of PB and magnetic nanoparticles, in the current study we aimed to strategically design and synthesize a highly efficient nano-magnetic bilirubin scavenger system based on iron oxides@prussian blue nanocomposites (Fe3O4@PB) NCs.

MATERIALS AND METHODS

The Fe3O4@PB NCs were synthesized by an improved shell-growing procedure and identified using advanced characteristic techniques TEM, SEM, XRD, DLS, and Zeta potential. Synthesized Fe3O4@PB NCs showed good magneton properties and also demonstrated dramatic absorbent properties that empower use as an eco-friendly adsorbent nano agent for the detoxification of toxins. In addition, Fe3O4@PB nanoparticles showed high performance of bilirubin absorption in the serum and blood of sickle cell anemia patients. (Temp. 37.7 ºC, the dose of adsorbent: 1 mg/mL, incubation time 30 min, and initial concentration: 0.25 mg/mL).

RESULTS

The results demonstrated an ideal adsorption capacity (86%) of Fe3O4@PB NCs which is significant compared to the reported adsorbents agents. These results pave the way for the application of Fe3O4@PB NCs for the effective purification of toxins from patients' body fluids.

The impact of Hydroxyurea on the rates of Vaso-occlusive crises in patients with sickle cell disease in Saudi Arabia: a single-center study

BACKGROUND

Vaso-occlusive crises (VOCs) are acute and common painful complication of sickle cell disease (SCD), and are the main reason behind the frequent emergency department visits among SCD patients. Hydroxyurea (HU) is an old and commonly used medication that demonstrated its effectiveness in reducing the risk of VOCs and the incidence of hospitalization. Although multiple studies have examined the impact of HU on the rates of VOCs, few have explored its effectiveness among SCD patients in Saudi Arabia.

METHODS

This was a single-center retrospective cohort study in which the electronic medical records of patients with SCD who have not had any previous exposure to HU prior to the initiation of HU treatment for ≥12 months were recruited. Paired t-test was conducted to examine the difference in the rates of VOCs, and levels of hemoglobin (Hgb), hematocrit (HCT), and platelet counts (PLT Ct) prior to the initiation of HU therapy and 12 months later. Multiple linear regression was conducted to examine whether age, gender, use of opioid analgesics, Hgb, HCT, and PLT Ct levels predict higher or lower rates of VOCs.

RESULTS

One hundred and fifty-six patients met the inclusion criteria and were included in the analysis. About 51% of the patients were males, and their mean age was 12.69 years. The mean HU dosage was 16.52 mg/kg/day, and the mean reduction in the rate of VOCs was 1.36 events per patient per year (95% CI [1.03-1.70], p < 0.0001) after the initiation of HU. Females were more likely to have greater reduction in the rates of VOCs in comparison to their male counterparts (β-estimate = 12.85, 95% CI [0.759-24.93], p = 0.0374).

CONCLUSION

The use of HU results in a significant reduction in the rates of VOCs and emergency department visits. Future studies with robust research designs should be conducted to further examine the impact of HU on VOCs, hospitalization, and length of stay as well as compare HU to other newly approved medications for SCD, such as crizanlizumab.

Utilization of Hydroxyurea Among Patients Diagnosed with Sickle Cell Disease in Jazan, Saudi Arabia

PURPOSE

The early diagnosis of sickle cell disease (SCD) patients and getting appropriate treatment are crucial for improving clinical outcomes. This study aims to assess the use of hydroxyurea among patients diagnosed with SCD and assess factors influencing the attitude toward the medication and the reasons for discontinuation.

METHODS

This study was a cross-sectional investigation targeting parents or caregivers of children diagnosed with SCD in the Jazan region of Saudi Arabia. Data were collected from tertiary healthcare hospitals via a self-administered questionnaire. The questionnaire was composed of sections measuring the participants' demographics, the number of children diagnosed with SCD, the use of hydroxyurea, and the parents' beliefs about hydroxyurea.

RESULTS

There were 301 parents or caregivers recruited. The majority of the recruited participants were mothers (54.5%), and nearly half of the sample were older than 35. More than 80% of the participants declare that one or more of their children are receiving hydroxyurea to manage SCD. The majority of participants declared that using hydroxyurea reduced the frequency of body pain episodes, emergency department visits, and hospital admissions. Participants' major concern about the use of hydroxyurea was related to the fear of weakening their immunity (29.5%) and hydroxyurea's perceived effect on fertility (16.8%). Furthermore, 52 (18%) of the participants declared that the use of hydroxyurea to manage the disease was stopped; the main reasons for stopping was their belief that hydroxyurea had side effects and its impact on weakening of their immune system.

CONCLUSION

The findings indicate the importance of increasing the role of clinicians in educating patients and caregivers about the use of hydroxyurea and its benefits.