[Epidemiological, clinical and hematological profiles of homozygous sickle cell disease during the intercritical period among children in Ziguinchor, Senegal]

Epidemiological and clinical characteristics of 66 Tunisian Sickle cell syndrome patients

Introduction

Sickle cell syndrome (SCS) represent a real health problem. In this work, we propose to study the epidemiological and clinical features of 66 patients with SCS.

Methods

This is a retrospective descriptive cross-sectional study carried out on a population of 66 patients with SCS, (36 S/S, 18 S/β-thalassemia, seven S/C and five S/OArab), over a period of two years.

Results

The average age of our population is 15.5 years ± 8.4. 36 patients (55%) were born to a consanguineous marriage and 35 (53%) had siblings with SCS. The average baseline hemoglobin in our patients is 9.1g/dL±1.51. S/C patients have significantly higher baseline hemoglobin than S/S, S/β-thalassemia and S/OArab with p <0.05. Jaundice, mucosal skin pallor and hepatomegaly have been observed only in S/S, S/β-thalassemia and S/OArab patients. The persistence of splenomegaly is more frequent in S/C than in S/S, and in S/-thalassemia than in S/S. The most common acute complications were vaso-occlusive attacks (69.7%) and worsening of anemia (54.54%). The most common chronic complication was cholelithiasis (36.36%).

Conclusion

S/C patients present the best tolerated form and were the least affected by chronic complications and therefore can lead an almost normal life.

[Platelet count in the steady state phase and clinical severity of sickle cell disease in a reference centre for sickle cell disease in Mali]

Risk factors associated with complications occurring in sickle cell disease are not fully elucidated. The purpose of this study was to evaluate the existence of an association between the clinical severity of sickle cell disease and platelet count in the steady state phase in patients with sickle cell disease followed up at the Center for Research and Control of Sickle Cell Disease in Bamako, Mali. We conducted a retrospective review of 40 medical records of patients aged 5 to 42 years with sickle cell disease at the Center for Research and Control of Sickle Cell Disease in Bamako, Mali. Clinical severity of sickle cell disease was assessed according to the criteria of VOC and/or hospitalizations < 2 or ≥ 2 per year. Data entry was carried out using the Excel 2013 version. The statistical tests used were the Chi2, Student and Mac Nemar tests. Of the 40 patients, 82.5% had haemolytic phenotype and 17.5% hyperviscous phenotype; complications of sickle cell disease were more frequent in the haemolytic phenotype group (p < 0.05). There was a significant association between mean platelet count ≥ 450 G/L in the steady state phase and the annual number of CVOs ≥ 2 (p = 0.002). This study shows that mean platelet count ≥ 450 G/L in sickle cell patients in the steady state phase could be a risk factor for the frequent occurrence of CVO. It underlines the importance of conducting prospective studies focusing on both hyperplateletosis and platelet activation markers in larger sample sizes, as well as therapeutic trials involving platelet activation inhibitors, such as Crizanlizumab, a humanised anti-P-selectin monoclonal antibodies.

Sickle Cell Disease in Mauritania: epidemiological, clinical and therapeutic aspects about 135 cases

OBJECTIVE

To describe the epidemiological, clinical and therapeutic characteristics of a series of sickle cell disease cases collected in Mauritania over a three-year period.

METHODS

This is a descriptive study of the profile of sickle cell disease, diagnosed in Mauritania, from January 1, 2015 to December 31, 2017, at the outpatient clinics of the National Hospital Center and at the Mauritanian Association for the Support of Sickle Cell Patients. Patients were included following diagnostic confirmation by hemoglobin electrophoresis.

RESULTS

During the study period, a total of 135 patients were included (79 female and 56 male), i.e. a sex ratio of 0.7 and an average age of 24 years (extremes: 9 months -77 years). All Mauritanian ethnic groups were affected by sickle cell disease, mainly the Peulths (63.7%). Sickle cell disease was found in eight wilayas, particularly Brakna (39%). The age of diagnosis was between 3 and 5 years, in 48% of patients. Sickle cell disease was discovered at the stage of complications in twelve patients. There are three types of sickle cell phenotypes: SS (54%), AS (40%) and SC (6%). In addition to transfusion, preventive treatment consisted of folic acid (n=53), hydroxyurea (n=14), and long-term antibiotic prophylaxis (n=3).

CONCLUSION

The profile of sickle cell disease in Mauritania remains attributed to the lack of an active screening strategy and rapid diagnosis, hence the importance of developing a national program for early detection and management.

Hybridized Zoonotic Schistosoma Infections Result in Hybridized Morbidity Profiles: A Clinical Morbidity Study amongst Co-Infected Human Populations of Senegal

Hybridization of infectious agents is a major emerging public and veterinary health concern at the interface of evolution, epidemiology, and control. Whilst evidence of the extent of hybridization amongst parasites is increasing, their impact on morbidity remains largely unknown. This may be predicted to be particularly pertinent where parasites of animals with contrasting pathogenicity viably hybridize with human parasites. Recent research has revealed that viable zoonotic hybrids between human urogenital Schistosoma haematobium with intestinal Schistosoma species of livestock, notably Schistosoma bovis, can be highly prevalent across Africa and beyond. Examining human populations in Senegal, we found increased hepatic but decreased urogenital morbidity, and reduced improvement following treatment with praziquantel, in those infected with zoonotic hybrids compared to non-hybrids. Our results have implications for effective monitoring and evaluation of control programmes, and demonstrate for the first time the potential impact of parasite hybridizations on host morbidity.

Improvement of SCD morbimortality in children: experience in a remote area of an African country

BACKGROUND

Sickle cell disease (SCD) is a public health problem in the Democratic Republic of Congo. While reference sickle cell centers have been implemented in capital cities of African countries and have proven to be beneficial for SCD patients. In the Democratic Republic of Congo, they have never been set up in remote areas for families with low or very low sources of income.

METHOD

A cohort of 143 children with SCD aged 10 years old (IQR (interquartile range): 6-15 years) (sex ratio male/female = 1.3) were clinically followed for 12 months without any specific intervention aside from the management of acute events, and then for 12 months with a monthly medical visit, biological follow-up, and chemoprophylaxis (folic acid/penicillin), adequate fluids and malaria prevention.

RESULTS

The median age of patients at the diagnosis of SCD was 2 years (IQR: 1-5). The implementation of standardized and regular follow-ups in a new sickle cell reference center in a remote city showed an increase in the annual mean hemoglobin level from 50 to 70 g/L (p = 0.001), and a decrease in the lymphocyte count and spleen size (p < 0.001). A significant decrease (p < 0.001) in the average annual number of hospitalizations and episodes of vaso-occlusive crises, blood transfusions, infections, and acute chest syndromes were also observed.

CONCLUSIONS

The creation of a sickle cell reference center and the regular follow-up of children with sickle cell disease are possible and applicable in the context of a remote city of an African country and represent simple and accessible measures that can reduce the morbimortality of children with sickle cell disease.

Sickle Cell Disease in the Democratic Republic of Congo: Assessing Physicians' Knowledge and Practices

Background: Sickle cell disease is a major public health issue in the Democratic Republic of Congo (DRC), but it is still poorly understood by health professionals. The objective of this study was to assess the knowledge and practices of Congolese physicians treating sickle cell disease (SCD), in order to identify the areas for improvement in clinical care. Methods: This was a descriptive observational study conducted among Congolese physicians using a questionnaire. Participants were evaluated using a pre-established answer grid. Results: A total of 460 physicians participated, including 81 women (18%), with an average age of 35 years (range 25–60 years). Most physicians were general practitioners. Although self-assessment of their level of knowledge on SCD was estimated as average to good, less than half of the participants (n = 460; 46%) reported adequate management of vaso-occlusive crises, and only 1% of them had received specific training on SCD. Most physicians reported difficulties both in terms of diagnostic (65%) and management (79%) options of SCD patients. This study also showed that 85% of these physicians did not have access to the diagnostic tools for SCD. Conclusions: Insufficient knowledge on SCD and poor diagnostic and treatment options might contribute to increased morbidity and mortality of patients living in the DRC. Interventions aiming to improve physicians’ knowledge, patient follow-up, and treatment access are needed. Specific training alongside existing programs (HIV, malaria), early diagnosis of the disease, and the creation of patient advocacy groups should be implemented to improve SCD patient care.