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Treves B, Sonnini E, La Russa R, Del Duca F, Ghamlouch A, De Matteis A, Trignano C, Marchal JA, Carrillo E, Napoletano G, Maiese A. Can Hemorrhagic Stroke Genetics Help Forensic Diagnosis in Pediatric Age (<5 Years Old)? Genes (Basel) 2024; 15:618. [PMID: 38790247 PMCID: PMC11120992 DOI: 10.3390/genes15050618] [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: 03/15/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
When stroke occurs in pediatric age, it might be mistakenly interpreted as non-accidental head injury (NAHI). In these situations, a multidisciplinary approach is fundamental, including a thorough personal and familial history, along with accurate physical examination and additional investigations. Especially when the clinical picture is uncertain, it is important to remember that certain genetic conditions can cause bleeding inside the brain, which may resemble NAHI. Pediatric strokes occurring around the time of birth can also be an initial sign of undiagnosed genetic disorders. Hence, it is crucial to conduct a thorough evaluation, including genetic testing, when there is a suspicion of NAHI but the symptoms are unclear. In these cases, a characteristic set of symptoms is often observed. This study aims to summarize some of the genetic causes of hemorrhagic stroke in the pediatric population, thus mimicking non-accidental head injury, considering elements that can be useful in characterizing pathologies. A systematic review of genetic disorders that may cause ICH in children was carried out according to the Preferred Reporting Item for Systematic Review (PRISMA) standards. We selected 10 articles regarding the main genetic diseases in stroke; we additionally selected 11 papers concerning patients with pediatric stroke and genetic diseases, or studies outlining the characteristics of stroke in these patients. The disorders we identified were Moyamoya disease (MMD), COL4A1, COL4A2 pathogenic variant, Ehlers-Danlos syndrome (E-D), neurofibromatosis type 1 (Nf1), sickle cell disease (SCD), cerebral cavernous malformations (CCM), hereditary hemorrhagic telangiectasia (HHT) and Marfan syndrome. In conclusion, this paper provides a comprehensive overview of the genetic disorders that could be tested in children when there is a suspicion of NAHI but an unclear picture.
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Affiliation(s)
- Biancamaria Treves
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (B.T.); (F.D.D.); (A.G.); (A.D.M.); (G.N.)
| | - Elena Sonnini
- Dipartimento Scienze della Vita e Sanità Pubblica, Medicina Genomica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (B.T.); (F.D.D.); (A.G.); (A.D.M.); (G.N.)
| | - Alessandro Ghamlouch
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (B.T.); (F.D.D.); (A.G.); (A.D.M.); (G.N.)
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (B.T.); (F.D.D.); (A.G.); (A.D.M.); (G.N.)
| | - Claudia Trignano
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43c, 07100 Sassari, Italy;
| | - Juan Antonio Marchal
- Centre for Biomedical Research (CIBM), Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, 18016 Granada, Spain; (J.A.M.); (E.C.)
- Instituto de Investigación Biosanitaria ibs. GRANADA, University of Granada, 18071 Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, 18016 Granada, Spain
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - Esmeralda Carrillo
- Centre for Biomedical Research (CIBM), Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, 18016 Granada, Spain; (J.A.M.); (E.C.)
- Instituto de Investigación Biosanitaria ibs. GRANADA, University of Granada, 18071 Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, 18016 Granada, Spain
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (B.T.); (F.D.D.); (A.G.); (A.D.M.); (G.N.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
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Zayed AM, Al-Muhaimeed S, Al-Otaibi T, Ali EM, Saleh R, Ancheta SJ, Al-Harbi F, Waheed KB, Albahli Y, Alghamdi H. Moyamoya Syndrome in Children With Sickle Cell Disease in Saudi Arabia: A Single-Center Experience. Cureus 2023; 15:e49039. [PMID: 38024048 PMCID: PMC10657488 DOI: 10.7759/cureus.49039] [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: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Sickle cell disease (SCD) is relatively common in Saudi Arabia. Its neurologic complications such as stroke and Moyamoya syndrome (MMS) can be severe and devastating. Such complications can be minimized by modern investigative tools such as transcranial Doppler (TCD) ultrasound, which is unavailable in many high-risk places. Our aim is to investigate the prevalence and characteristics of these complications in children with SCD in our center where TCD is not available. Methods We conducted a retrospective record review of children with SCD admitted to the pediatric ward and visited the pediatric hematology outpatient clinic of King Fahad Military Medical Complex, Dhahran, Saudi Arabia, from January 2010 to December 2021. The target population was children aged six months to 14 years with SCD and a history of stroke or transient ischemic attacks (TIAs). Their magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) of the brain radiographic features were reviewed. A descriptive analysis was used to summarize the demographic characteristics and clinical features of patients with and without MMS. Results Twenty-six children (out of 385 with sickle cell anemia, originating mainly from the southwestern and eastern provinces of Saudi Arabia) experienced an overt stroke with an overall prevalence of 6.7%. All patients with stroke were originally from the Southwestern province. Their genotype was SS, and the median age at the onset of the first stroke was six years (IQR: 5.5). The main presenting symptoms were seizures (57.7%), motor weakness (42.3%), headache (15.3%), cranial nerve palsies (11.5%), cognitive deficit (7.6%), and dysphasia (3.8%). The majority of strokes were ischemic (92.3%). MMS was detected in 61.5% and was seen at the onset of the first stroke in all patients with this MRA abnormality. Seven children with moyamoya (43.8%) had recurrent strokes. Conclusion In this study, the prevalence of overt stroke is 9% in children with SCD originating from the southwestern region of Saudi Arabia (26/286), and 61.5% of them (16/26) had MMS. It is absent in the children of Eastern origin (99 children). In places lacking TCD facilities, further studies are required to determine if MRA brain screenings of children with SCD may detect MMS before the onset of stroke and help start protective therapy.
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Affiliation(s)
- Abdalla M Zayed
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Turki Al-Otaibi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Rashid Saleh
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Fahad Al-Harbi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Yasir Albahli
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | - Hamid Alghamdi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
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3
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Mahmoud AA, Abd El Naby SA, Abdelgawad AS, Rizq MS, Abd El Hady NMS. Brain-derived neurotrophic factor and neuroimaging in pediatric patients with sickle cell disease. Pediatr Res 2023:10.1038/s41390-023-02513-5. [PMID: 36774398 DOI: 10.1038/s41390-023-02513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND The risk of neurological complications is increased in children with sickle cell disease (SCD), such as silent cerebral infarction (SCI) and stroke. Brain-Derived Neurotrophic Factor (BDNF) is a nerve growth factor associated with elevated transcranial Doppler (TCD) velocities and increased risk of stroke in SCD patients. So, we assessed the BDNF level in children with SCD and its relation to neurological complication as silent stroke. METHODS A comparative cross-sectional study was conducted on 40 patients with SCD, recruited from the Hematology Unit, Pediatric Department, Menoufia University Hospital, and 40 healthy children as controls. Laboratory investigations including BDNF were done. TCD was done for all patients and Magnetic Resonance Imaging (MRI) was done on high-risk patients. RESULTS BDNF levels were significantly higher in children with SCD than in controls with a significant relation to TCD findings. There was a statistically significant diagnostic ability of BDNF in the prediction of SCD complications as its sensitivity was 89.5%, specificity (95% CI) was 80% with a cut-off point >0.69, AUC = 0.702, and p = 0.004). CONCLUSION Serum BDNF levels were higher in sickle disease patients who had abnormal transcranial Doppler. BDNF had a significant diagnostic ability in the detection of SCD complications. IMPACT Silent stroke is a very serious complication in children with sickle cell disease, so regular follow up should be every six months. BDNF is considered a potential biomarker for stroke risk prediction in patients unable to receive TCD.
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Affiliation(s)
- Asmaa A Mahmoud
- Department of Pediatrics-Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt.
| | - Sameh A Abd El Naby
- Department of Pediatrics-Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Ahmed S Abdelgawad
- Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin Elkom, Egypt
| | - Marwa Sabry Rizq
- Department of Pediatrics, National Liver Institute, Menoufia University, Shebin Elkom, Egypt
| | - Nahla M S Abd El Hady
- Department of Pediatrics-Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
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4
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Aguwa CJ, Cannon AD, Casella JF, Shapiro BK, Lance EI. Current developmental screening practices in young children with sickle cell disease. Br J Haematol 2023; 200:377-380. [PMID: 36454537 PMCID: PMC10862534 DOI: 10.1111/bjh.18575] [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: 07/20/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
Despite recent developmental screening guidelines, rates of neurodevelopmental disorders (NDDs) remain lower than expected in children with sickle cell disease (SCD). A retrospective chart review identified 276 eligible patients; 214 charts were available for developmental screening and 207 charts for autism-specific screening. Developmental surveillance/screening was conducted in 70% of charts and autism-specific screening in 19% of charts. Validated tools were used in 32% of developmental screenings and 92% of autism-specific screenings. Many children (57%) were screened outside recommended ages. In conclusion, children with SCD are not regularly receiving appropriate developmental screening and surveillance by their healthcare providers.
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Affiliation(s)
- Chibuzo J. Aguwa
- Neurodevelopmental Medicine, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland, USA
- School of Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Alicia D. Cannon
- Neuropsychology, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - James F. Casella
- Pediatrics, Division of Hematology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bruce K. Shapiro
- Neurodevelopmental Medicine, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland, USA
- Pediatrics, Division of Hematology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eboni I. Lance
- Neurodevelopmental Medicine, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland, USA
- Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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5
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Lance EI, Cannon AD, Casella JF, Shapiro BK. Neurocognitive screening in sickle cell disease. Pediatr Blood Cancer 2022; 69:e29861. [PMID: 35716349 DOI: 10.1002/pbc.29861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Eboni I Lance
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alicia D Cannon
- Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - James F Casella
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bruce K Shapiro
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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6
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Almasoudi EA, Magliah SF, Alzwaihri AS, Aljuwaybiri AO, Alqahtani AS. Incidence of eye complications among sickle cell disease patients in Jeddah, Saudi Arabia: A cross-sectional study. Ann Med Surg (Lond) 2022; 79:103999. [PMID: 35860146 PMCID: PMC9289312 DOI: 10.1016/j.amsu.2022.103999] [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: 04/26/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Sickle cell disease (SCD) is a heritable blood disorder resulting in deformed, rigid red blood cells, rendering them more prone to vaso-occlusion. Ocular complications are known to affect multiple organs through the body's vasculature. Here, we evaluated the incidence of eye complications in patients with SCD at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Materials and methods We used a cross-sectional approach and collected relevant medical data from nine patients with SCD. Ophthalmic assessment included visual acuity and an in-clinic dilated fundus examination. All patients were asked to attend the ophthalmology clinic to undergo optical coherence tomography (OCT) angiography, macular OCT scan, and fundus photography. The results of the imaging tests were interpreted by a certified ophthalmology consultant specializing in retinal diseases. Descriptive analyses of the results were also performed. Results The mean age of the nine patients was 24.78 ± 10.9 years. All patients were non-hypertensive, one had type 1 diabetes, and another had type 2 diabetes. Five patients had normal visual acuity, two had slight impairments in at least one eye, and two had moderate impairment in at least one eye. One of the nine patients exhibited retinal ischemia in the right eye despite normal macular thickness (visual acuity, OD, 6/30; OS, 6/21). The remaining eight patients showed no ocular abnormalities. Conclusion Of the nine patients with SCD, five showed no symptoms of ocular complications. One patient showed retinal ischemia in the right eye, despite a normal macular thickness. This study's results suggest routine ophthalmologic examination may not be able to detect or monitor macular or retinal abnormalities unless augmented with detailed imaging techniques. Out of nine patients with SCD, five patients exhibited normal visual acuity. One patient presented perifoveal retinal ischemia in the right eye. Results suggest augmenting routine ophthalmology screening with imaging techniques.
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7
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Padda J, Khalid K, Syam M, Kakani V, Kankeu Tonpouwo G, Dhakal R, Padda S, Cooper AC, Jean-Charles G. Association of Anemia With Epilepsy and Antiepileptic Drugs. Cureus 2021; 13:e19334. [PMID: 34909297 PMCID: PMC8653853 DOI: 10.7759/cureus.19334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/27/2022] Open
Abstract
Epilepsy is a disorder that causes unprovoked seizures regularly. It affects between 1% and 3% of the population. After the first seizure, the chances of having another one are almost 40%-52%. The etiology of febrile seizures in children with sickle cell disease is still unknown. In some groups, iron deficiency anemia has been linked to an increased risk of seizures. Although the reason and process are uncertain, some people believe that taking iron supplements can help prevent seizures. This literature covers haptene, non-haptene immune-related hemolysis, and oxidative processes activated by anti-seizure medications (ASMs). In epileptic patients, ASMs can cause anemia. Folic acid can be given to carbamazepine-treated anemic patients. There is growing evidence that it improves hemoglobin and leukocytes in individuals who take it. Therefore, one of the most efficient strategies to avoid future seizures is to take ASMs daily to maintain an even level of anticonvulsant in the body. To prevent further seizures, lifestyle changes are essential. Further studies and clinical trials are warranted to prove a clear association between epilepsy and hematologic disease, which will improve quality of life in the future.
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Affiliation(s)
| | | | | | | | | | - Richa Dhakal
- Internal Medicine, JC Medical Center, Orlando, USA
| | | | | | - Gutteridge Jean-Charles
- Internal Medicine, JC Medical Center, Orlando, USA.,Internal Medicine, AdventHealth and Orlando Health Hospital, Orlando, USA
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8
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Lagunju IA, Labaeka A, Ibeh JN, Orimadegun AE, Brown BJ, Sodeinde OO. Transcranial Doppler screening in Nigerian children with sickle cell disease: A 10-year longitudinal study on the SPPIBA cohort. Pediatr Blood Cancer 2021; 68:e28906. [PMID: 33522690 DOI: 10.1002/pbc.28906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary stroke prevention programmes for children with sickle cell disease (SCD) have been shown to be feasible interventions in resource-poor countries. Different hydroxyurea (HU) regimens have been utilised in ameliorating the severity of SCD. OBJECTIVE To determine the long-term outcomes of the stroke prevention programme for children with SCD in Ibadan (SPPIBA), Nigeria. METHODS A longitudinal study of 396 children with haemoglobin SS disease who had been on the stroke prevention programme for a minimum period of 5 years. All enrollees had nonimaging TCD performed at baseline and thereafter 3-monthly or annually. Children with TCD velocities ≥170 cm/s were treated with HU by dose-escalation regimen. RESULTS The mean age at first TCD examination was 102 ± 46.7 months and the period of follow-up ranged from 5 to 10 years (mean = 7.2 ± 1.7). Time to significant decline in TCD velocities ranged from 5 to 35 months, (median = 10.0 months). The minimum dose of HU required to achieve significant decline in TCD velocities ranged from 15 to 31 mg/kg/day, mean 23.7 (±3.9). HU dose escalation beyond 20 mg/kg/day was required to attain significant reductions in the time-averaged mean of maximal velocities (TAMMV) in 69.1% of the cases. Two stroke events occurred giving a stroke incidence of 0.08 per 100 patient-years. CONCLUSION The majority of Nigerian children with SCD and elevated TCD velocities achieved significant decline in TAMMV within the first year of HU therapy but on higher doses of HU. It might be important to individualise HU doses for optimal outcomes in primary stroke prevention.
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Affiliation(s)
- IkeOluwa A Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Adeyemi Labaeka
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Joy N Ibeh
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Adebola E Orimadegun
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Biobele J Brown
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Olugbemiro O Sodeinde
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
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Benítez-Carabante MI, Beléndez C, González-Vicent M, Alonso L, Uría-Oficialdegui ML, Torrent M, Pérez-Hurtado JM, Fuster JL, Cela E, Díaz-de-Heredia C. Matched sibling donor stem cell transplantation for sickle cell disease: Results from the Spanish group for bone marrow transplantation in children. Eur J Haematol 2021; 106:408-416. [PMID: 33296531 DOI: 10.1111/ejh.13566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The prevalence of sickle cell disease (SCD) in Spain is markedly inferior compared with other European and Mediterranean countries. However, the diagnosis of new patients with SCD is expected to increase. In this multicenter retrospective study, we analyze the hematopoietic stem cell transplantation (HSCT) results obtained in Spain. METHODS Forty-five patients who underwent a matched sibling donor (MSD) HSCT between 1999 and 2018 were included. Primary endpoint was event-free survival (EFS), and secondary endpoints included acute and chronic graft-versus-host disease (GvHD) and overall survival (OS). RESULTS Bone marrow was the most frequent stem cell source (93.3%). Most patients received a conditioning regimen based on busulfan and cyclophosphamide (69%). Cumulative incidence of grade III-IV acute GvHD and chronic GvHD was 6.8% (95% CI: 2.3%-20.1%) and 5.4% (95% CI: 1.38%-19.9%), respectively. EFS and overall survival (OS) at 3 years post-HSCT were 89.4% (95% CI: 73.9%-95.9%) and 92.1% (95% CI: 77.2%-97.4%), respectively. All patients aged ≤ 5 presented 100% EFS and OS. CONCLUSIONS An early referral to HSCT centers should be proposed early in life, before severe complications occur. MSD HSCT should be considered a curative option for all patients aged ≤ 5 years and for older pediatric patients who present complications derived from the disease.
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Affiliation(s)
- María Isabel Benítez-Carabante
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Cristina Beléndez
- Department of Pediatric Hematology and Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta González-Vicent
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Laura Alonso
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - María Luz Uría-Oficialdegui
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Monserrat Torrent
- Department of Pediatric Hematology and Oncology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - José Luis Fuster
- Department of Pediatric Hematology and Oncology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Elena Cela
- Department of Pediatric Hematology and Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Díaz-de-Heredia
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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10
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Ibemere SO, Dubbs SB, Barnhart HX, Brown JL, Freiermuth CE, Kavanagh P, Paice JA, Strouse JJ, Wilkerson RG, Tanabe P. Trial design of comparing patient-specific versus weight-based protocols to treat vaso-occlusive episodes in sickle cell disease (COMPARE-VOE). Contemp Clin Trials 2020; 101:106252. [PMID: 33348066 DOI: 10.1016/j.cct.2020.106252] [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: 05/13/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Painful vaso-occlusive episodes (VOE) are the most common reason for emergency department (ED) visits experienced by patients with sickle cell disease (SCD). The National Heart, Lung and Blood Institute (NHLBI) evidence-based recommendations for VOE treatment are based primarily on expert opinion. In this randomized controlled trial (RCT), we will compare changes in pain scores between patients randomized to a patient-specific analgesic protocol versus those randomized to a weight-based analgesic protocol, as recommended by the NHLBI guidelines. METHODS We report the rationale and design of a multi-site, phase III, single-blinded, RCT to be conducted in six EDs in the United States. Eligible participants will be randomized after providing consent, anticipating 50% of those randomized would have an ED visit during the enrollment period. A total of 230 participants with one VOE ED visit provides sufficient power to detect a clinically significant difference in pain score reductions of 14 between groups with 0.05 type I error. Uniquely, this trial randomizes participants in a larger population than the study population, given the impossibility of consenting and randomizing participants during emergencies. The primary endpoint is the change in pain scores in the ED from time of placement in treatment area to time of disposition (hospitalization, discharged home, or assigned to observation status) or a maximum treatment duration of 6 hours. Additional outcomes include hospitalizations and ED visits seven days post enrollment, side effects, and safety assessments. CONCLUSIONS The COMPARE-VOE study design will provide high-level evidence to support the NHLBI VOE treatment guidelines.
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Affiliation(s)
- Stephanie O Ibemere
- School of Nursing, Duke University, Durham, NC 27710, United States of America.
| | - Sarah B Dubbs
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Huiman X Barnhart
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University, Durham, NC, 27710, United States of America
| | - Jacqueline L Brown
- School of Nursing, Duke University, Durham, NC 27710, United States of America
| | - Caroline E Freiermuth
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267, United States of America
| | - Patricia Kavanagh
- Division of General Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA 02118, United States of America
| | - Judith A Paice
- Division of Hematology-Oncology, Northwestern University; Feinberg School of Medicine, Chicago, IL 606011, United States of America
| | - John J Strouse
- Division of Hematology, Department of Medicine, and Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - R Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Paula Tanabe
- Schools of Nursing and Medicine, Duke University, Durham, NC 27710, United States of America
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de la Fuente J, Gluckman E, Makani J, Telfer P, Faulkner L, Corbacioglu S. The role of haematopoietic stem cell transplantation for sickle cell disease in the era of targeted disease-modifying therapies and gene editing. LANCET HAEMATOLOGY 2020; 7:e902-e911. [PMID: 33242447 DOI: 10.1016/s2352-3026(20)30283-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/27/2022]
Abstract
Sickle cell disease is one of the most common, life-threatening, non-communicable diseases in the world and a major public health problem. Following the implementation of simple preventive and therapeutic modalities, infant mortality has almost been abolished in high-income countries, but only a small amount of progress has been made in improving survival in adulthood. Progressive end-organ damage, partly related to a systemic vasculopathy, is increasingly recognised. With the availability of a variety of novel disease-modifying drugs, gene addition and gene editing strategies, matched sibling donor haematopoietic stem cell transplantation (HSCT) in children (offering an overall survival rate of 95% and an event-free survival rate of 92%), and encouraging outcomes after alternative donor HSCT, the new challenge is to risk stratify patients, revise transplantation indications, and define the best therapeutic approach for each patient. The ultimate challenge will be to enable these advances in low-income and middle-income countries, where disease prevalence is highest and where innovative strategies are most needed.
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Affiliation(s)
- Josu de la Fuente
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Eliane Gluckman
- Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Julie Makani
- Department of Haematology and Blood Transfusion, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, Barts Health NHS Trust, London, UK
| | | | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany.
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Downes M, Keenan L, Duane Y, Duffy K, Fortune G, Geoghegan R, Conroy H, McMahon C. Executive function in children with sickle cell anemia on transfusion: NIH toolbox utility in the clinical context. Clin Neuropsychol 2020; 36:1573-1588. [PMID: 33200651 DOI: 10.1080/13854046.2020.1847325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to establish the utility of the NIH Toolbox as a cognitive screener of executive functions in the clinical context. Additionally, we aimed to investigate whether age and time on transfusion were related to executive function performance. Method: Twenty-eight children and adolescents with sickle cell anemia (SCA) between 8 and 18 years (M = 13.28, SD = 3.05) on transfusion treatment were included. Participants completed five NIH Toolbox tasks (three executive function tasks and two non-executive function control tasks). Results: Mean scores on one of the three executive function measures (inhibitory control) fell below the average range (M = 81.36, SD = 14.01) with approximately 70% of children from both groups below the average range. Scores for processing speed (M = 86.82, SD = 22.01) and cognitive flexibility (M = 85.75, SD = 12.67) were low averages. As expected, scores on non-executive measures (language and memory) fell within the average range. No significant differences were observed between children with silent stroke and no stroke on executive function measures. Older age (p < .01) and length of time on transfusion (p < .05) predicted lower inhibitory control scores. Conclusions: Findings provide evidence for poor development of inhibitory control with age in this patient population. As the NIH Toolbox successfully highlighted expected deficits in this patient population, this study supports the use of this tool as a brief screening measure for children with SCD. The clinical and theoretical implications of the findings are discussed.
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Affiliation(s)
- M Downes
- School of Psychology, University College Dublin, Dublin, Ireland
| | - L Keenan
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Y Duane
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - K Duffy
- School of Psychology, University College Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - G Fortune
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - R Geoghegan
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - H Conroy
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - C McMahon
- Children's Health Ireland at Crumlin, Dublin, Ireland
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