ABSTRACT
A prospective study was conducted to study the splenic function among sickle cell anemia (SCA) patients in Qatif (Eastern Province of Saudi Arabia). Seventy-seven patients (30 children and 47 adults aged 2-57 years) were included. (99m)Tc stannous colloid liver-spleen scan was done for each patient during steady state. The splenic function was graded from 0 to 4 in relation to liver uptake. Seventy percent of our patients showed evidence of splenic hypofunction, and most of them (83%) had severe hyposplenism. Up to the age of 4 years, only 17% of the children showed evidence of functional hyposplenism, but by the age of 10 years >50% were hyposplenic. Most of the hyposplenic children had functional hyposplenism, whereas only one-third of hyposplenic adults had autosplenectomy. There was no effect of level of HbF on the frequency of hyposplenism, but on the other hand low MCV seems to be protective against hyposplenism. A significant number of adult SCA patients have clinically enlarged spleens, and almost a third have normally functioning spleens. Because of the low prevalence of hyposplenism in children younger than 4 years of age, routine penicillin prophylaxis is probably not indicated in this population, an issue which needs further evaluation.
Subject(s)
Anemia, Sickle Cell/epidemiology , Splenic Diseases/diagnostic imaging , Splenic Diseases/epidemiology , Adolescent , Adult , Age Distribution , Child , Child, Preschool , Clinical Trials as Topic , Comorbidity , Erythrocyte Indices , Female , Fetal Hemoglobin/metabolism , Hepatomegaly/diagnosis , Humans , Liver/diagnostic imaging , Male , Middle Aged , Mononuclear Phagocyte System/diagnostic imaging , Prevalence , Prospective Studies , Radionuclide Imaging , Saudi Arabia/epidemiology , Sex Distribution , Spleen/diagnostic imaging , Splenic Diseases/diagnosis , Splenomegaly/diagnosis , Technetium Compounds , Tin FluoridesABSTRACT
BACKGROUND: Isoxsuprine is a tocolytic agent which improves erythrocyte deformability. It was accidentally found to be effective in the management of sickle cell disease (SCD) painful crises. The experience with the drug in the treatment of sickle cell disease is limited. This double-blind randomized comparative study was undertaken to test its efficacy and safety in the treatment of SCD painful crises. PATIENTS AND METHODS: Forty-three SCD patients (33 males and 10 females) with 44 episodes of pain were included in the study (i.e., one patient was included twice). Only those with painful crises requiring hospital admission were included. Patients were randomized to receive either isoxsuprine 5-10 mg, or meperidine 50100 mg intramuscularly, according to body weight, every four hours. A random selection of 23 patients received isoxsuprine, and 21 received meperidine. Pain score, duration of crisis, hospital stay, and side effects were monitored. RESULTS: No significant difference was found in any parameter except for pain score at 30 and 60 minutes. CONCLUSION: We conclude that isoxsuprine appears to be effective in the treatment of sickle cell painful crises. Confirmation of its efficacy in studies involving a larger number of patients is warranted.
ABSTRACT
Sensorineural hearing loss (SNHL) is a known complication of sickle cell disease (SCD). There is a paucity of information on this problem in Sausi SCD patients. A prospective controlled study was conducted over 27 months in Qatif Central Hospital. One hundred patients with sickle cell anemia (SCA), aged five to 40 years, were studied. The control group consisted of 100 healthy individuals. A detailed history, otologic and audiologic examinations were carried out on both groups. Further investigations to rule out local retrocochlear pathology were performed on those having unilateral SNHL. No case of SNHL was detected in the control group, while it was recorded in 19 (19%) of SCA patients, 13 males and six females. There was a significant association between the SNHL and the onset of first vaso-occlusive crisis at six years of age or less. There was no significant difference in the frequency of SNHL between children and adults. Twenty-one percent of patients who had SNHL completely recovered. Patients with SCD need a careful regular hearing assessment. Those detected to have SNHL need a careful plan implemented by both the clinician and otolaryngologist for proper care of this important complication.
ABSTRACT
A controlled prospective study was carried out between 16 July 1991 and 31 January 1992 to evaluate the oropharyngeal flora in homozygous sickle cell disease (SS). Throat swabs for cultures were taken from 163 asymptomatic SS patients attending sickle cell clinics (90 children and 73 adults). Throat swabs were also taken from 84 asymptomatic healthy individuals as a control group (44 children and 40 adults). Group A beta hemolytic Streptococci were isolated from 16.6% of children with SS compared to 4.5% of children without SS (P<0.05). Staphylococcus aureus was isolated from 16.4% of adults with SS compared to 0% of adults without SS (P<0.0001). Group G beta hemolytic Streptococci and nongroupable Streptococci were also isolated from 11% and 13.7% of adults with SS compared to 0% and 2.5% of adults without SS respectively. Several other organisms were isolated only from SS patients. We conclude that the oropharyngeal flora of patients with SS is disturbed. This disturbance may contribute to morbidity of these patients.
