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Masamu U, Sangeda RZ, Kandonga D, Ondengo J, Ndobho F, Mmbando B, Nkya S, Msami K, Makani J. Patterns and patient factors associated with loss to follow-up in the Muhimbili sickle cell cohort, Tanzania. BMC Health Serv Res 2020; 20:1141. [PMID: 33317526 PMCID: PMC7737273 DOI: 10.1186/s12913-020-05998-6] [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] [Received: 02/21/2020] [Accepted: 12/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring patient's clinical attendance is a crucial means of improving retention in care and treatment programmes. Sickle cell patients' outcomes are improved by participation in comprehensive care programmes, but these benefits cannot be achieved when patients are lost from clinical care. In this study, patients are defined as loss to follow-up when they did not attend clinic for more than 9 months. Precise information on the retention rate and characteristics of those who are not following their clinic appointments is needed to enable the implementation of interventions that will be effective in increasing the retention to care. METHOD This was a retrospective study involving sickle cell patients registered in the Muhimbili Sickle Cohort in Tanzania. Descriptive and survival analysis techniques both non-parametric methods (Kaplan-Meier estimator and Log-rank test) and semi-parametric method (Cox's proportional hazard model), were used. A p-value of 0.05 was considered significant to make an inference from the analysis. RESULTS A total of 5476 patients were registered in the cohort from 2004 to 2016. Of these, 3350 (58.13%) were actively participating in clinics, while 2126 (41.87%) were inactive, of which 1927 (35.19%) were loss to follow-up. We used data from 2004 to 2014 because between 2015 and 2016, patients were referred to other government hospitals. From the survival analysis results, pediatric (HR: 14.29,95% CI: 11.0071-18.5768, p < 0.001) and children between 5 and 17 years [HR:2.61,95% CI:2.2324-3.0705, p < 0.001] patients were more likely to be loss to follow-up than the adult (18 and above years) patients. It was found that patients with above averages for hematocrit (HR: 2.38, 95% CI: 1.0076-1.0404, p = 0.0039) or mean cell volume (HR: 4.28, (95% CI: 1.0260-1.0598, p < 0.001) were more likely to be loss to follow-up than their counterparts. CONCLUSION Loss to follow-up is evident in the cohort of patients in long term comprehensive care. It is, therefore, necessary to design interventions that improve patients' retention. Suggested solutions include refresher training for health care workers and those responsible for patient follow-up on techniques for retaining patients and comprehensive transition programs to prepare patients who are moving from pediatric to adult clinics.
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Affiliation(s)
- Upendo Masamu
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.
| | - Raphael Z Sangeda
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.,Department of Pharmaceutical Microbiology, Muhimbili University of Healthy and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel Kandonga
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania
| | - Jesca Ondengo
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania
| | - Flora Ndobho
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Bruno Mmbando
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.,National Institute for Medical Research, Tanga, Tanzania
| | - Siana Nkya
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.,Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Khadija Msami
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.,Department of Hematology and Blood Transfusion, Muhimbili University of Healthy and Allied Sciences, Dar es Salaam, Tanzania
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Ko K, Lee CW, Nam S, Ahn SV, Bae JH, Ban CY, Yoo J, Park J, Han HW. Epidemiological Characterization of a Directed and Weighted Disease Network Using Data From a Cohort of One Million Patients: Network Analysis. J Med Internet Res 2020; 22:e15196. [PMID: 32271154 PMCID: PMC7180516 DOI: 10.2196/15196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/08/2019] [Accepted: 01/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background In the past 20 years, various methods have been introduced to construct disease networks. However, established disease networks have not been clinically useful to date because of differences among demographic factors, as well as the temporal order and intensity among disease-disease associations. Objective This study sought to investigate the overall patterns of the associations among diseases; network properties, such as clustering, degree, and strength; and the relationship between the structure of disease networks and demographic factors. Methods We used National Health Insurance Service-National Sample Cohort (NHIS-NSC) data from the Republic of Korea, which included the time series insurance information of 1 million out of 50 million Korean (approximately 2%) patients obtained between 2002 and 2013. After setting the observation and outcome periods, we selected only 520 common Korean Classification of Disease, sixth revision codes that were the most prevalent diagnoses, making up approximately 80% of the cases, for statistical validity. Using these data, we constructed a directional and weighted temporal network that considered both demographic factors and network properties. Results Our disease network contained 294 nodes and 3085 edges, a relative risk value of more than 4, and a false discovery rate-adjusted P value of <.001. Interestingly, our network presented four large clusters. Analysis of the network topology revealed a stronger correlation between in-strength and out-strength than between in-degree and out-degree. Further, the mean age of each disease population was related to the position along the regression line of the out/in-strength plot. Conversely, clustering analysis suggested that our network boasted four large clusters with different sex, age, and disease categories. Conclusions We constructed a directional and weighted disease network visualizing demographic factors. Our proposed disease network model is expected to be a valuable tool for use by early clinical researchers seeking to explore the relationships among diseases in the future.
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Affiliation(s)
- Kyungmin Ko
- Department of Biomedical Informatics, CHA University of Medicine, Seongnam, Republic of Korea.,Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, WA, United States
| | - Chae Won Lee
- Department of Biomedical Informatics, CHA University of Medicine, Seongnam, Republic of Korea.,Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Sangmin Nam
- Department of Ophthalmology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Song Vogue Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Jung Ho Bae
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Chi Yong Ban
- Department of Biomedical Informatics, CHA University of Medicine, Seongnam, Republic of Korea.,Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Jongman Yoo
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam, Republic of Korea.,Department of Microbiology, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jungmin Park
- Department of Nursing, School of Nursing, Hanyang University, Seoul, Republic of Korea
| | - Hyun Wook Han
- Department of Biomedical Informatics, CHA University of Medicine, Seongnam, Republic of Korea.,Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam, Republic of Korea
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Muhammad A, Waziri AD, Forcados GE, Sanusi B, Sani H, Malami I, Abubakar IB, Muhammad A, Muhammad RA, Mohammed HA. Sickling-suppressive effects of chrysin may be associated with sequestration of deoxy-haemoglobin, 2,3-bisphosphoglycerate mutase, alteration of redox homeostasis and functional chemistry of sickle erythrocytes. Hum Exp Toxicol 2019; 39:537-546. [PMID: 31876182 DOI: 10.1177/0960327119895815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sickle cell disease (SCD) is a medical condition caused by mutation in a single nucleotide in the β-globin gene. It is a health problem for people in sub-Saharan Africa, the Middle East and India. Orthodox drugs developed so far for SCD focus largely on symptomatic respite of pain and crisis mitigation. We investigated the antisickling effects of chrysin via modulation of deoxy-haemoglobin, 2,3-bisphosphoglycerate mutase, redox homeostasis and alteration of functional chemistry in human sickle erythrocytes. In silico and in vitro methods were adopted for the studies. Chrysin was docked against deoxy-haemoglobin and 2,3-bisphosphoglycerate mutase, with binding energies (-24.064 and -18.171 kcal/mol) and inhibition constant (K i) of 0.990 µM and 0.993 µM at their active sites through strong hydrophobic and hydrogen bond interactions. Sickling was induced with 2% metabisulphite at 3 h. Chrysin was able to prevent sickling maximally at 2.5 µg/mL and reversed the same at 12.5 µg/mL, by 66.5% and 69.6%, respectively. Treatment with chrysin significantly (p < 0.05) re-established the integrity of erythrocytes membrane as evident from the observed percentage of haemolysis relative to induced erythrocytes. Chrysin also significantly (p < 0.05) prevented and reversed lipid peroxidation. Similarly, glutathione and catalase levels were observed to significantly (p < 0.05) increase with concomitant significant (p < 0.05) decrease in superoxide dismutase activity relative to untreated. From Fourier-transform infrared results, treatment with chrysin was able to favourably alter the functional chemistry, judging from the shifts and functional groups observed. Sickling-suppressive effects of chrysin may therefore be associated with sequestration of deoxy-haemoglobin, 2,3-bisphosphoglycerate mutase, alteration of redox homeostasis and functional chemistry of sickle erythrocytes.
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Affiliation(s)
- A Muhammad
- Faculty of Life Sciences, Department of Biochemistry, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - A D Waziri
- Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - G E Forcados
- Faculty of Life Sciences, Department of Biochemistry, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - B Sanusi
- Faculty of Life Sciences, Department of Biochemistry, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - H Sani
- Department of Medicine, Kaduna State University, Kaduna State, Nigeria
| | - I Malami
- Faculty of Pharmaceutical Sciences, Department of Pharmacognosy and Ethnopharmacy, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - I B Abubakar
- Faculty of Life Sciences, Department of Biochemistry, Kebbi State University of Science and Technology, Aliero, Kebbi State, Nigeria
| | - A Muhammad
- Faculty of Life Sciences, Department of Biochemistry, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - R A Muhammad
- Faculty of Life Sciences, Department of Biochemistry, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - H A Mohammed
- Faculty of Life Sciences, Department of Biochemistry, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
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Prevalence and Factors Associated with Human Parvovirus B19 Infection in Sickle Cell Patients Hospitalized in Tanzania. Mediterr J Hematol Infect Dis 2019; 11:e2019054. [PMID: 31528320 PMCID: PMC6736168 DOI: 10.4084/mjhid.2019.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/08/2019] [Indexed: 11/11/2022] Open
Abstract
Background The distribution of human parvovirus B19 (HPV B19) infection is ubiquitous and occurs worldwide. The virus has high tropism to red blood cells progenitor’s cells leading to temporary infection of bone marrow and transient arrest of erythropoiesis. People with frequent episodes of hemolytic anemia including sickle cell disease (SCD) and thalassemia are at increased risk of infection. This study aimed at assessing prevalence and factors associated with HPV B19 infections among hospitalized SCD patients. Methodology This was a cross-sectional hospital-based study among SCD patients hospitalized at Muhimbili National Hospital. HPV B19 was detected using RT-PCR. Hematological and Chemistry tests were done using Sysmex XT2000i and Chemistry analyzer respectively. Results A total of 329 SCD patients, median age 15 years (interquartile range 7–22 years) were tested for HPV B19. The prevalence of HPV B19 was 29%. In multivariate logistic regression model, HPV B19 infection was associated with pain (OR=4.28, 95%CI: 1.20–15.19; p=0.025), low neutrophil counts (OR=0.57, 95%CI: 0.35–0.92, p=0.022) and MCH (OR=0.92, 95%CI: 0.85–0.99; p=0.033). Individuals infected with HPV B19 had slightly higher prevalence of severe anaemia (30.4% vs. 20.3%, p=0.054) and HIV infection (6.0% vs. 2.1%, p=0.083) in the univariate analysis. Considering the effect of HPV B19 virus on spleen, aplastic anemia and platelet counts in SCD patients, our study did not find any association with these parameters (p=0.244; p= 0.205 and p=0.567 respectively). Conclusion The prevalence of HPV B19 among hospitalized SCD patients at MNH was high. SCD patients with HPV B19 were more likely to present with pain, low neutrophils levels, and MCH. HIV infection might be associated with a high risk of HPV infection in SCD patients; however, this requires further investigation.
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Muhammad A, Waziri AD, Forcados GE, Sanusi B, Sani H, Malami I, Abubakar IB, Oluwatoyin HY, Adinoyi OA, Mohammed HA. Sickling-preventive effects of rutin is associated with modulation of deoxygenated haemoglobin, 2,3-bisphosphoglycerate mutase, redox status and alteration of functional chemistry in sickle erythrocytes. Heliyon 2019; 5:e01905. [PMID: 31297461 PMCID: PMC6597891 DOI: 10.1016/j.heliyon.2019.e01905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 12/23/2022] Open
Abstract
Sickle cell anaemia is a hereditary disease branded by an upsurge in generation of ROS, irregular iron release and little or no antioxidant activity which can lead to cellular injuries due to oxidative stress resulting in severe symptoms including anaemia and pain. The disease is caused by a mutated version of the gene that helps make haemoglobin, the protein that carries oxygen in red blood cells. We used in silico and in vitro experiments to examine the antisickling effects of rutin for the first time by means of before and after induction approaches in sickle erythrocytes. Rutin was docked against deoxy-haemoglobin and 2,3-bisphosphoglycerate mutase, revealing binding energies (-27.329 and -25.614 kcal/mol) and Ki of 0.989μM and 0.990 μM at their catalytic sites through strong hydrophobic and hydrogen bond interactions. Sickling was thereafter, induced at 3 h with 2% metabisulphite. Rutin prevented sickling maximally at 12.3μM and reversed same at 16.4μM, by 78.5% and 69.9%, one-to-one. Treatment with rutin significantly (P < 0.05) reinvented the integrity of erythrocytes membrane as evident from the practical % haemolysis compared to induced erythrocytes. Rutin also significantly (P < 0.05) prevented and reversed lipid peroxidation relative to untreated. Likewise, GSH, CAT levels were observed to significantly (P < 0.05) increase with concomitant significant (P < 0.05) decrease in SOD activity based on administration of rutin after sickling induction approach. Furthermore, FTIR results showed that treatment with rutin favourably altered the functional chemistry, umpiring from shifts and functional groups observed. It can thus be deduced that, antisickling effects of rutin may be associated with modulation of deoxy-haemoglobin, 2,3-bisphosphoglycerate mutase, alteration of redox homeostasis and functional chemistry of sickle erythrocytes.
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Affiliation(s)
- Aliyu Muhammad
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Aliyu Dahiru Waziri
- Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Gilead Ebiegberi Forcados
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Babangida Sanusi
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Hadiza Sani
- Department of Medicine, Kaduna State University, Kaduna State, Nigeria
| | - Ibrahim Malami
- Department of Pharmacognosy and Ethnopharmacy, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, PMB 2346, Sokoto, Nigeria
| | - Ibrahim Babangida Abubakar
- Department of Biochemistry, Faculty of Life Sciences, Kebbi State University of Science and Technology, Aliero, PMB 1144, Kebbi State, Nigeria
| | - Habeebah Yahya Oluwatoyin
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Otaru Abdulrasheed Adinoyi
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Hafsat Abdullahi Mohammed
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
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