A case report of primary hyperparathyroidism in an adolescent during Ramadan fast

Primary hyperparathyroidism is rare in children and usually presents with nonspecific symptoms. Ramadan fasting has been reported to unmask the diagnosis of primary hyperparathyroidism. A 15-year-old boy presented to the clinic for an emergency department follow up visit. He had started Ramadan fasting a week before his presentation to the clinic. He reported unintentional weight loss, abdominal pain, constipation, frequent headaches, exercise intolerance, tiredness, and palpitations. Physical examination was unremarkable except that he looked tired. Investigations revealed elevated calcium and parathyroid hormone, hypophosphatemia, low vitamin D, and parathyroid adenoma. He underwent parathyroidectomy, leading to a decrease in parathyroid hormone levels. He did well postoperatively, and by his 11-month follow-up visit, his calcium was back to a normal level, he was energetic, and had gained weight. A high index of suspicion is required to diagnose primary hyperparathyroidism in young patients, especially young Ramadan-fasting patients, who mostly present with vague nonspecific symptoms.

Evidence-based interventions for reducing sickle cell disease-associated morbidity and mortality in sub-Saharan Africa: A scoping review

Objective

Sickle cell disease is a lifelong illness affecting millions of people globally, but predominantly burdensome in sub-Saharan Africa, where most affected children do not live to adulthood, despite available evidence-based interventions that reduce the disease burden in high-income countries.

Method

We reviewed studies evaluating evidence-based interventions that decrease sickle cell disease-related morbidity and mortality among children living in sub-Saharan Africa. We used the Joanna Briggs scoping review methodological framework and grouped identified evidence-based interventions into preventative pharmacotherapeutic agents, newborn screening and comprehensive healthcare, disease-modifying agents, nutritional supplementation, systemic treatment, supportive agents and patient/carer/population education.

Results

We included 36 studies: 18 randomized controlled trials, 11 observational studies, 5 before-and-after studies and 2 economic evaluation studies, with most of the studies performed in West African countries. Included studies suggest evidence-based interventions effectively to reduce the common morbidities associated with sickle cell disease such as stroke, vaso-occlusive crisis, acute chest syndrome, severe anaemia and malaria infection. Evidence-based interventions also improve survival among study participants. Specifically, our review shows hydroxyurea increases haemoglobin and foetal haemoglobin levels, a finding with practical implications given the challenges with blood transfusion in this setting. The feasibility of implementing individual interventions is hampered by challenges such as affordability, accessibility and the availability of financial and human resources.

Conclusion

Our review suggests that regular use of low-dose hydroxyurea therapy, sulphadoxine-pyrimethamine chemoprophylaxis, L-arginine and Omega-3 fatty acid supplementation and establishment of specialist stand-alone sickle cell clinics could reduce the sickle cell disease-associated morbidity and mortality in sub-Saharan Africa countries.