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Mokhtar G, Abdelbaky A, Adly A, Ezzat D, Abdel Hakeem G, Hassab H, Youssry I, Ragab I, Sherief LM, Zakaria M, Hesham M, Salama N, Salah N, Afifi RAA, El-Ashry R, Makkeyah S, Adolf S, Amer YS, Omar TEI, Bussel J, Abd El Raouf E, Atfy M, Ellaboudy M, Florez I. Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology-A Limited-Resource Country Perspective. Children (Basel) 2024; 11:452. [PMID: 38671669 PMCID: PMC11048986 DOI: 10.3390/children11040452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Thrombocytopenia is a prevalent presentation in childhood with a broad spectrum of etiologies, associated findings, and clinical outcomes. Establishing the cause of thrombocytopenia and its proper management have obvious clinical repercussions but may be challenging. This article provides an adaptation of the high-quality Clinical Practice Guidelines (CPGs) of pediatric thrombocytopenia management to suit Egypt's health care context. METHODS The Adapted ADAPTE methodology was used to identify the high-quality CPGs published between 2010 and 2020. An expert panel screened, assessed and reviewed the CPGs and formulated the adapted consensus recommendations based on the best available evidence. DISCUSSION The final CPG document provides consensus recommendations and implementation tools on the management of isolated thrombocytopenia in children and adolescents in Egypt. There is a scarcity of evidence to support recommendations for various management protocols. In general, complete clinical assessment, full blood count, and expert analysis of the peripheral blood smear are indicated at initial diagnosis to confirm a bleeding disorder, exclude secondary causes of thrombocytopenia and choose the type of work up required. The International Society of Hemostasis and thrombosis-Bleeding assessment tool (ISTH-SCC BAT) could be used for initial screening of bleeding manifestations. The diagnosis of immune thrombocytopenic purpura (ITP) is based principally on the exclusion of other causes of isolated thrombocytopenia. Future research should report the outcome of this adapted guideline and include cost-analysis evaluations.
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Affiliation(s)
- Galila Mokhtar
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Ashraf Abdelbaky
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Amira Adly
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Dina Ezzat
- Pediatric Hematology Unit, Pediatric Department, Beni-Suef University, Beni-Suef 62521, Egypt;
- Pediatric Department, October 6 University, Giza 12585, Egypt
| | - Gehan Abdel Hakeem
- Pediatric Hematology and Oncology Unit, Pediatric Department, Minia University, Minia 61519, Egypt;
| | - Hoda Hassab
- Pediatric Hematology and Oncology Unit, Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt;
| | - Ilham Youssry
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Iman Ragab
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Laila M. Sherief
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Marwa Zakaria
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Mervat Hesham
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Niveen Salama
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Nouran Salah
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Rasha A. A. Afifi
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Rasha El-Ashry
- Pediatric Hematology and Oncology Unit, Pediatric Department, Mansoura University, Mansoura 35516, Egypt;
| | - Sara Makkeyah
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Sonia Adolf
- Pediatric, Hematology Department, Institute of Medical Research and Clinical Studies, National Research Center, Giza 1770, Egypt;
| | - Yasser S. Amer
- Pediatrics Department, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia;
- Research Chair for Evidence Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (FMRP-USP), Ribeirao Preto 14040-900, SP, Brazil
| | - Tarek E. I. Omar
- Pediatrics Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt;
| | - James Bussel
- Pediatrics Department, Well Cornell Medical College, New York, NY 10065, USA;
| | - Eman Abd El Raouf
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Mervat Atfy
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Mohamed Ellaboudy
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Ivan Florez
- Department of Pediatrics, University of Antioquia, Medellin 050010, Colombia;
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Mokhtar G, Adly A, Baky AA, Ezzat D, Hakeem GA, Hassab H, Youssry I, Ragab I, Florez I, Sherief LM, El-Ekiaby M, Zakaria M, Hesham M, Shaheen N, Salama N, Salah N, Afifi RAA, El-Ashry R, Youssef S, Ragab S, Habib SA, Omar T, Amer Y, Wali Y, Makkeyah S. Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using 'Adapted ADAPTE'. Ann Hematol 2024; 103:1373-1388. [PMID: 38388746 PMCID: PMC10940419 DOI: 10.1007/s00277-024-05657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.
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Affiliation(s)
- Galila Mokhtar
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Amira Adly
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Ashraf Abdel Baky
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Pediatrics, MTI University, Cairo, Egypt
- Department of Pediatrics, Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Dina Ezzat
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Beni Suef University, Beni Suef, Egypt
| | - Gehan Abdel Hakeem
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Minia University, Minia, Egypt
| | - Hoda Hassab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Alexandria University, Alexandria, Egypt
| | - Ilham Youssry
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Iman Ragab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Ivan Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Laila M Sherief
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Magdy El-Ekiaby
- Department of Clinical Pathology and Transfusion Medicine, Shabrawishi Hospital, Cairo, Egypt
| | - Marwa Zakaria
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Mervat Hesham
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Naglaa Shaheen
- Pediatric Hematology Department, Misr Children's Hospital, Health Insurance Organization, Cairo, Egypt
| | - Niveen Salama
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Nouran Salah
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Rasha A A Afifi
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Rasha El-Ashry
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Mansoura University, Monsoura, Egypt
| | - Salwa Youssef
- Department of Clinical Pathology and Transfusion Medicine, Ain Shams University, Cairo, Egypt
| | - Seham Ragab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Menoufia University, Menoufia, Egypt
| | - Sonia A Habib
- Pediatric Hematology and Oncology Unit, National Research Center, Giza, Egypt
| | - Tarek Omar
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Amer
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Department of Pediatrics, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser Wali
- Pediatric Hematology/Oncology Unit, Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sara Makkeyah
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt.
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Elalfy MS, Hamdy M, Adly A, Ebeid FSE, Temin NT, Rozova A, Lee D, Fradette C, Tricta F. Efficacy and safety of early-start deferiprone in infants and young children with transfusion-dependent beta thalassemia: Evidence for iron shuttling to transferrin in a randomized, double-blind, placebo-controlled, clinical trial (START). Am J Hematol 2023; 98:1415-1424. [PMID: 37401738 DOI: 10.1002/ajh.27010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Abstract
Children with transfusion-dependent thalassemia (TDT) require regular blood transfusions that, without iron-chelation therapy, lead to iron-overload toxicities. Current practice delays chelation therapy (late-start) until reaching iron overload (serum ferritin ≥1000 μg/L) to minimize risks of iron-depletion. Deferiprone's distinct pharmacological properties, including iron-shuttling to transferrin, may reduce risks of iron depletion during mild-to-moderate iron loads and iron overload/toxicity in children with TDT. The early-start deferiprone (START) study evaluated the efficacy/safety of early-start deferiprone in infants/young children with TDT. Sixty-four infants/children recently diagnosed with beta-thalassemia and serum ferritin (SF) between 200 and 600 μg/L were randomly assigned 1:1 to receive deferiprone or placebo for 12 months or until reaching SF-threshold (≥1000 μg/L at two consecutive visits). Deferiprone was initiated at 25 mg/kg/day and increased to 50 mg/kg/day; some recipients' dosages increased to 75 mg/kg/day based on iron levels. The primary endpoint was the proportion of patients ≥SF-threshold by month 12. Monthly transferrin saturation (TSAT) assessment evaluated iron-shuttling. At baseline, there was no significant difference in mean age (deferiprone: 3.03 years, placebo: 2.63 years), SF (deferiprone: 513.8 μg/L, placebo: 451.7 μg/L), or TSAT (deferiprone: 47.98%, placebo: 43.43%) between groups. At month 12, there was no significant difference in growth or adverse event (AE) rates between groups. No deferiprone-treated patients were iron-depleted. At month 12, 66% of patients receiving deferiprone remained below SF threshold versus 39% of placebo (p = .045). Deferiprone-treated patients showed higher TSAT levels and reached ≥60% TSAT threshold faster. Early-start deferiprone was well-tolerated, not associated with iron depletion, and efficacious in reducing iron overload in infants/children with TDT. TSAT results provide the first clinical evidence of deferiprone shuttling iron to transferrin.
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Affiliation(s)
- Mohsen S Elalfy
- Department of Pediatric Hematology, Ain Shams University, Children's Hospital, Cairo, Egypt
| | - Mona Hamdy
- Research Center, Cairo University, Cairo, Egypt
| | - Amira Adly
- Department of Pediatric Hematology, Ain Shams University, Children's Hospital, Cairo, Egypt
| | - Fatma S E Ebeid
- Department of Pediatric Hematology, Ain Shams University, Children's Hospital, Cairo, Egypt
| | | | - Anna Rozova
- Chiesi Canada Corporation, Toronto, Ontario, Canada
| | - David Lee
- Chiesi Canada Corporation, Toronto, Ontario, Canada
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Ebeid F, Adly A, Makkeyah S, Mostafa S, Ragab I. Poster: ALL-098: COVID-19 in Children with Cancer: What We Learned from the First Wave. Clinical Lymphoma Myeloma and Leukemia 2021. [PMCID: PMC8404083 DOI: 10.1016/s2152-2650(21)01290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Elalfy M, Adly A, Eltonbary K, Elghamry I, Elalfy O, Maebid M, Elsayh K, Elsayed HTAN, El Ekiaby M. Management of children with glucose-6-phosphate dehydrogenase deficiency presenting with acute haemolytic crisis during the SARs-COV-2 pandemic. Vox Sang 2021; 117:80-86. [PMID: 34105166 PMCID: PMC8242654 DOI: 10.1111/vox.13123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 12/31/2022]
Abstract
Background and Objectives Shortage of blood during the severe acute respiratory syndrome‐COV‐2 (SARs‐COV‐2) pandemic impacted transfusion practice. The primary aim of the study is to assess management of acute haemolytic crisis (AHC) in glucose‐6‐phosphate dehydrogenase(G6PD)‐ deficient children during SARs‐COV‐2 pandemic, and then to assess blood donation situation and the role of telemedicine in management. Methods Assessment of G6PD‐deficient children attending the Emergency Department (ER) with AHC from 1 March 2020 for 5 months in comparison to same period in the previous 2 years, in three paediatric haematology centres. AHC cases presenting with infection were tested for SARs‐COV‐2 using RT‐PCR. Children with Hb (50–65 g/L) and who were not transfused, were followed up using telemedicine with Hb re‐checked in 24 h. Results A 45% drop in ER visits due to G6PD deficiency‐related AHC during SARs‐COV‐2 pandemic in comparison to the previous 2 years was observed. 10% of patients presented with fever and all tested negative for COVID‐19 by RT‐PCR. 33% of patients had Hb < 50 g/L and were all transfused. 50% had Hb between 50 and 65 g/L, half of them (n = 49) did not receive transfusion and only two patients (4%) required transfusion upon follow up. A restrictive transfusion strategy was adopted and one of the reasons was a 39% drop in blood donation in participating centres. Conclusion Fewer G6PD‐deficient children with AHC visited the ER during SARs‐COV‐2 and most tolerated lower Hb levels. Telemedicine was an efficient tool to support their families. A restrictive transfusion strategy was clear in this study.
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Affiliation(s)
- Mohsen Elalfy
- Paediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amira Adly
- Paediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Khadiga Eltonbary
- Paediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Islam Elghamry
- Paediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Omar Elalfy
- Complementary Medicine Department, National Research Center, Giza, Egypt
| | - Mohamed Maebid
- Paediatrics Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Khaled Elsayh
- Paediatrics Department, Faculty of Medicine, Assuit University, Assiut, Egypt
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Serag H, El Wakeel L, Adly A. Coenzyme Q10 administration has no effect on sICAM-1 and metabolic parameters of pediatrics with type 1 diabetes mellitus. INT J VITAM NUTR RES 2020; 91:315-324. [PMID: 31942840 DOI: 10.1024/0300-9831/a000636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Endothelial dysfunction (ED) plays a key role in the development and progression of microvascular and macrovascular complications in pediatrics with type 1 diabetes mellitus (T1DM). Coenzyme Q10 (CoQ10) is a nutraceutical with a known anti-inflammatory and anti-oxidant activity. This study was conducted to evaluate the potential effect of CoQ10 on ED and various metabolic parameters. Methods: This prospective randomized open-label pilot study was conducted on 49 T1DM pediatric patients. Seven healthy non-diabetic pediatric subjects who didn't receive treatment were included as a control group. Eligible patients were randomly allocated into either group I (n = 25); received 100 mg of CoQ10 in addition to standard treatment or group II (n = 24); received standard treatment only. The levels of; soluble intracellular adhesion molecule-1 (sICAM-1), glycated hemoglobin (HbA1c), fasting blood glucose (FBG), lipid profile, serum creatinine and liver function tests were assessed for both groups at baseline and after 3 months of treatment. Results: At baseline, compared to an age-matched healthy control group sICAM-1 levels were significantly elevated in group II diabetic patients (276.5 (231.6-320.66) vs 221.8 (177.9-267.1 ng/ml), p = 0.042. After 3 months of treatment no significant difference was observed in sICAM-1, HbA1c, FBG, lipid profile, serum creatinine and liver function tests between the two study groups. A positive correlation was found between sICAM-1 and HbA1c throughout the study (r = 0.308, p = 0.0054). Conclusion: Administration of CoQ10 for 3 months in T1DM pediatric patients was well tolerated but had no favorable effect on ED or metabolic parameters.
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Affiliation(s)
- Heba Serag
- Department of Clinical Pharmacy, Faculty of Pharmacy Ain Shams University, Cairo, Egypt
| | - Lamia El Wakeel
- Department of Clinical Pharmacy, Faculty of Pharmacy Ain Shams University, Cairo, Egypt
| | - Amira Adly
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Elalfy MS, Adly A, Awad H, Tarif Salam M, Berdoukas V, Tricta F. Safety and efficacy of early start of iron chelation therapy with deferiprone in young children newly diagnosed with transfusion-dependent thalassemia: A randomized controlled trial. Am J Hematol 2018; 93:262-268. [PMID: 29119631 DOI: 10.1002/ajh.24966] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 12/28/2022]
Abstract
Iron overload is inevitable in patients who are transfusion dependent. In young children with transfusion-dependent thalassemia (TDT), current practice is to delay the start of iron chelation therapy due to concerns over toxicities, which have been observed when deferoxamine was started too early. However, doing so may increase the risk of iron accumulation that will be manifested as toxicities later in life. This study investigated whether deferiprone, a chelator with a lower affinity for iron than deferoxamine, could postpone transfusional iron overload while maintaining a good safety profile. Recently diagnosed TDT infants (N = 64 their age ranged from 10 to 18 (median 12) months, 54.7% males; receiving ≤6 transfusions; serum ferittin (SF) >400 to < 1000 ng/mL were randomized to "early start deferiprone" (.ES-DFP) at a low dose (50 mg/kg/day) or to "delay chelation" (DC), and remained in the study until their serum ferritin (SF) level reached ≥1000 μg/L. 61 patients continued the study Levels of transferrin saturation (TSAT) and labile plasma iron (LPI) were measured as well. By approximately 6 months postrandomization, 100% of the subjects in DC group had achieved SF > 1000 µg/L and TSAT > 70% compared with none in the ES-DFP group. LPI level > 0.6 µM was observed in 97% vs. 40% of the DS and ES groups, respectively, (P < 0.001). The time to reach SF > 1000 µg/L was delayed by 6 months in the ES-DFP group (P < 0.001) without escalating DFP dose. No unexpected, serious, or severe adverse events were seen in the ES-DFP group.
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Affiliation(s)
| | - Amira Adly
- Hematology Center; Children Hospital, Ain Shams University; Cairo Egypt
| | - Hanem Awad
- Department of Tanning Materials and Leather Technology National Research Center; Cairo Egypt
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Adly A, Abd-El-Hafiz S. An energy minimization approach to vector hysteresis modeling in objects having arbitrary shapes. 2015 IEEE Magnetics Conference (INTERMAG) 2015. [DOI: 10.1109/intmag.2015.7156871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abstract
BACKGROUND The spectrum of diabetic heart disease involves a progression from normal heart to preclinical left ventricular diastolic and systolic dysfunction followed by overt echocardiographic evidence of left ventricular (LV) dysfunction and finally symptomatic heart failure. OBJECTIVE To compare the value of tissue Doppler imaging (TDI) over the conventional echocardiography in the assessment of early myocardial dysfunction in type 1 diabetics in correlation with serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP), state of metabolic control, and diabetes duration. METHODS Sixty subjects were included; 40 type 1 diabetics (aged 12-18 years). Twenty matched subjects served as controls. They were subjected to clinical examination with assessment of cardiovascular reflexes for autonomic neuropathy. Laboratory investigations included mean random blood sugar (MRBS), hemoglobin A1c (HbA1c), urinary microalbumin, and serum determination of NT-pro-BNP. Echocardiography for chamber dimensions, systolic and diastolic function, Tie index, and longitudinal myocardial global biventricular function by pulsed TDI of 6 LV walls and right ventricle (RV) free wall. RESULTS All diabetics and controls had normal LV dimensions, LV mass index and systolic functions except for higher left ventricular posterior wall (LVPW) in diabetics (P < 0.05). LV and RV diastolic dysfunction diagnosed in 25% of diabetics by conventional Doppler with higher peak A (P < 0.05, P < 0.05) and lower E/A (P < 0.05, P < 0.05) compared to controls. Diabetics had larger Tie index (P < 0.05). TDI showed delayed myocardial relaxation in 52.5% of diabetics with lower LV and RV peak Em (P < 0.05, P < 0.01) and Em/Am (P < 0.01, P < 0.001) compared to controls. NT-pro-BNP was elevated in diabetics (P < 0.01) with best cut-off value = 62.5 Fmol/mL, sensitivity (82%), and specificity (95%) for detection of isolated diastolic dysfunction in diabetics. It was correlated negatively with LV Em (P < 0.05), Em/Am (P < 0.01) and positively with Am (P < 0.01), impaired diastolic velocities were associated with higher HbA1c. CONCLUSION Asymptomatic diabetics had evidence of subtle right and LV dysfunction with delayed myocardial relaxation which was related to metabolic control. Tissue Doppler (TD) has an additional value in evaluating ventricular filling. NT-pro-BNP is considered a sensitive, specific, and predictive marker for diastolic dysfunction.
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Affiliation(s)
- Mona Salem
- Paediatrics Department, Ain Shams University, Cairo, Egypt.
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