Demographic and Treatment Status of Thalassaemia Patients in a Tertiary Hospital in Bangladesh

2020 ◽  
Vol 4 (02) ◽  
pp. 44-48
Author(s):  
Md. Jamal Uddin Tanin ◽  
Fatiha Tasmin Jeenia ◽  
Fahmida Ahamed ◽  
Mushfiqul Abrar
Keyword(s):  
Disease Process ◽  
Iron Chelation ◽  
Life Time ◽  
Clinical History ◽  
Tertiary Hospital ◽  
Socioeconomic Background ◽  
Thalassaemia Major ◽  
Related Factors ◽  
The Mean ◽  
Thalassaemia Intermedia

Introduction: Thalassaemia is now effectively treated with adequate blood transfusion and iron chelation. The disease process itself and iron overload from blood transfusions together produce multiple complications. Objective: Due to increased life expectancy of thalassaemia patients it is important to point out demographic profiles and clinical history related factors that may vary due to numerous causes. Therefore, objective of this study may lead to know the obstacles to access treatment and to find solutions to prevent complications in our socioeconomic background. Methodology: Three clinical types of thalassaemia were assessed in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Total 109 subjects with thalassaemia were included in the study according to the inclusion criteria. They were distributed as thalassaemia major (33 subjects), thalassaemia intermedia (34 subjects) and thalassaemia minor (42 subjects). The patients were asked questions regarding demographic status and some clinical histories through a questionnaire. After compilation of the data statistical analysis was done accordingly. Results: The mean age of the subjects in years were 22.7 in thalassaemia major, 22.09 in thalassaemia intermedia and 22.5 in thalassaemia minor with nearly equal gender distributions. Students constituted 27.27% among thalassaemia major, 32.35% among thalassaemia intermedia and 30.95% among thalassaemia minor. The participants were educated up to primary level by 51.52% in thalassaemia major, 47.06 % in thalassaemia intermedia and 57.14 % in thalassaemia minor. Most of the subjects were Muslims and over 75% of the subjects came from outside the Dhaka the city. The mean number of life time transfusions were 105.33 in the patients of thalassaemia major, 33.85 in the intermedia and 0.76 in the minor. Iron chelation were done in 48.48% of thalassaemia major and 17.64% of thalassaemia intermedia at some point of their treatment.  Splenectomy was done in 5 (15.15%) of thalassaemia major and 2 (5.8%) in thalassaemia intermedia patients. Before enrolment in the study 9.09% thalassaemia major, 50% intermedia and 83% minor subjects never visited haematologists or haematology OPD. Conclusion: Most of the subjects were at their working age and students and had to take treatment from inter-district facilities. Majority of the patients with thalassaemia intermedia and minor never consulted haematologists. Transfusion frequency was high with inadequate iron chelation.

Effectiveness of Structured Teaching Programme (STP) on knowledge Regarding Selected Minor Ailments of Newborn among Primipara Mothers Admitted in PNC ward, AIIMS Raipur

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Shafna Abdulla TP ◽  
Shafna Abdulla TP ◽  
Shafna Abdulla TP ◽  
Shafna Abdulla TP ◽  
Shafna Abdulla TP ◽  
...  
Keyword(s):  
Disease Process ◽  
Sampling Technique ◽  
Life Time ◽  
Teaching Programme ◽  
Structured Teaching ◽  
Post Test ◽  
Minor Ailments ◽  
The Mean ◽  
Emotional Events ◽  
Structured Questionnaire

Newborn babies constitute the foundation of life. The birth of a baby is one of the most awe inspiring and emotional events that can occur in one’s life time. In India most the mothers are not aware of management regarding minor disorder of newborn (vomiting, diarrhea, physiological jaundice conjunctivitis, umbilical cord infection, skin rashes etc). Mother plays an important role in the identifying minor developmental deviation and early evidences of the disease process because she is constantly and closely watching her baby. Methodology: pre experimental (one group pretest and posttest) design was adopted for this study. The study was conducted at postnatal ward AIIMS Raipur with sample size of 30 primipara mothers. Non probability convenient sampling technique was adopted to select the sample. The data was collected by means of self-structured questionnaire to assess the knowledge among primipara mothers. Result: The mean score of pre-test was 15.36 and mean score of post-test was 22.4 and the mean improvement was 7.04, which is 45.83% of total primipara mothers. The paired ‘t’ value obtained for knowledge was 10.41 which was found significant at 0.05 level (p<0.05) which is 2.05. Which result shows that significantly an improvement in the knowledge of the primipara mothers after the structured teaching programme (STP) on selected minor ailments of newborn.

MRI Evidence of Cardiac Iron Accumulation in Myelodysplasia and Unusual Anaemias.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1553-1553 ◽  
Author(s):  
Julie Glanville ◽  
Perla Eleftheriou ◽  
John Porter
Keyword(s):  
Iron Overload ◽  
Sickle Cell ◽  
Sickle Cell Anaemia ◽  
Iron Chelation ◽  
Iron Accumulation ◽  
Thalassaemia Major ◽  
Cardiac Iron ◽  
Sideroblastic Anaemia ◽  
Cardiac Iron Overload ◽  
Thalassaemia Intermedia

Abstract Iron overload is a well described complication of multiple transfusions. Cardiac failure secondary to myocardial iron accumulation is the leading cause of death in thalassaemia major patients, and survival is improved with iron chelation. Identifying patients at risk of complications from iron overload is now more widely available with the MRI T2* technique. Iron chelation improves survival in thalassaemia major patients, but the significant practical difficulties limit its use in acquired anaemias. It has recently been suggested that abnormal cardiac T2* values do not occur in multitransfused elderly patients with aquired sideroblastic anaemia (RARS) (Winder et al Blood 2005 106: Abstract 2536). Here we examine the frequency of cardiac iron accumulation as evidenced by a shortening of the myocardial T2* value in multi transfused patients with myelodysplasia (MDS), sickle cell anaemia, and other transfusion dependent anaemias, including diamond blackfan anaemia (DBA) and pyruvate kinase deficiency (PKD). Method: Database records of cardiac magnetic resonance T2* values were assessed on 41 non sickle, non thalassaemia patients, 131 thalassaemia major and intermedia and 37 sickle cell patients, where a shortening of the cardiac T2* value below 20ms is associated with iron overload. 7 patients with MDS were assesed for transfusion duration and intensity, iron chelation and hepatic T2* values. Results: 14 out of 41 (34%) patients with non-sickle, non-thalassaemia transfusion dependent anaemia had abnormal cardiac T2* values, compared with 48% of thalassaemia major patients,13% thalassaemia intermedia and 2.7% sickle cell anaemia Table1. Table 1: Percentage of patients with Cardiac iron overload as evidenced by MRI T2* <20ms in unusual anaemias, thalassaemias and sickle cell anaemia DIAGNOSIS NO. PATIENTS AVERAGE AGE (Yrs) NO. PATIENTS WITH T2*<20 ms Hb H 2 40.5 (35–46) O Haemolytic Anaemia Unknown Cause 1 11 0 Osteopetrosis 1 49 0 AML/BMT/MF 5 26.4 (6–49) 1 (20%) Myelodysplasia 1 41 0 CDA 1 41 0 Erythropoietic Porphyria 1 40 0 Red Cell Aplasia 2 36 (35–37) 0 DBA 7 25 (9–36) 5 (71%) PKD 9 26.2 (14–47) 2 (22%) Congenital Sideroblastic Anaemia 4 35.3 (22–64) 3 (75%) Thalassaemia major 108 26 (1– 51) 52 (48%) Thalassaemia intermedia 23 34.6 (14–60) 3 (13%) Sickle Cell Anaemia 37 37.5 (21–58) 1 (2.7%) In patients with MDS, cardiac iron overload occurs between 2 and 4 years of consistent transfusion, but may not occur even after 12 years. Transfusion intensity but not total blood volume is higher in those with cardiac iron load. Hepatic iron overload is more severe in those with cardiac iron overload, and ferritin values are higher (Average 5865 ug/l v 2832 ug/l) but neither predicts cardiac iron load One out of three patients with T2* under 20ms was heterozygous for C282Y and one heterozygous for H63D.Table2. Table 2: A comparison of transfusion intensity, duration, iron chelation and hepatic T2* values in patients with and without cardiac iron overload in myelodysplasia MYELODYSPLASIA T2* < 20 T2* > 20 Number of Patients 3 4 Average Years of Transfusion (yrs) 208 204 Average No of Red Cell Units Transfused 3.3 (2–4) 6.1 (2–12) Average Hepatic T2*(ms) 1.4 (1.2–1.6) 4.7 (1.2–14.7) Proportion on iron chelation 1/3 2/4 Average Units/Year 51.3 40.1 Conclusion: Iron accumulation can occur in elderly patients with myelodysplasia after only two years of transfusion. Early consideration of iron chelation is appropriate and additional risk factors, eg inheritance of HFE gene mutations should be determined.

scholarly journals Patient Perspective on Iron Chelation Therapy: Barriers and Facilitators of Medication Adherence

2021 ◽  
Vol 8 ◽  
pp. 237437352199695
Author(s):  
Chia Chee Chong ◽  
Adyani Md Redzuan ◽  
Jameela Sathar ◽  
Mohd Makmor-Bakry
Keyword(s):  
Medication Adherence ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Barriers And Facilitators ◽  
Iron Chelation Therapy ◽  
Related Factors ◽  
Factors Affecting ◽  
Patient Health

Nonadherence to iron chelation therapy (ICT) remains a long-standing and serious issue in thalassemia, especially in resource-constrained developing countries. Barriers and facilitators of adherence to ICT in transfusion-dependent thalassemia (TDT) adult patients in Malaysia are not completely understood. This qualitative study explored factors affecting adherence to ICT among TDT adult patients at a public tertiary hospital in Malaysia. Data were collected through 21 semistructured in-depth interviews conducted among purposively sampled patients using a pretested interview guide. All interviews were audio-recorded and transcribed verbatim. Data were analyzed manually using thematic analysis method and managed using Atlas.Ti software. The most frequently discussed subthemes of barriers to adherence included patient-related factors, medications-related factors, sociocultural-related factors, environmental context and resources, and patient–health care provider relationship factors. The facilitators to adherence included having insights of their illness, prevailing sources of motivation emphasizing on strong self-efficacy, low medication burden, and having enabling environment. This study has identified barriers and facilitators that are unique to Malaysian thalassemic adults related to medication adherence. Options for future multifaceted interventions are suggested.

Marrow proliferation as a cause of hearing loss in beta-thalassaemia major

2007 ◽  
Vol 122 (11) ◽  
pp. 1253-1256 ◽  
Author(s):  
D Thio ◽  
V Prasad ◽  
P Anslow ◽  
P Lennox
Keyword(s):  
Hearing Loss ◽  
Chelation Therapy ◽  
Disease Process ◽  
Iron Chelation ◽  
Ossicular Chain ◽  
Thalassaemia Major ◽  
Beta Thalassaemia ◽  
Marrow Expansion ◽  
Desferrioxamine Therapy ◽  
New Onset

AbstractObjective:The aim of this report was to highlight the fact that hearing loss in thalassaemia patients can be related to marrow expansion affecting the ossicles, resulting in a conductive loss.Case report:A six-year-old boy with transfusion-dependent beta-thalassaemia developed a unilateral hearing loss shortly after commencing desferrioxamine therapy. Otoxicity was assumed, but the deficit was later found to be of a conductive nature, due to marrow proliferation within the ossicular chain as a consequence of the disease process – a phenomenon previously unreported in the literature.Conclusion:It is important to elucidate the precise nature of new onset hearing loss in patients receiving iron chelation therapy, in order to avoid unnecessary cessation of much needed medication, on the assumption of ototoxicity.

scholarly journals Quality of life and its related factors in women with substance use disorders referring to substance abuse treatment centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Majid Barati ◽  
Khadijeh Bandehelahi ◽  
Tahereh Nopasandasil ◽  
Hanieh Jormand ◽  
Amir Keshavarzi
Keyword(s):  
Quality Of Life ◽  
Substance Abuse ◽  
Substance Use ◽  
Substance Abuse Treatment ◽  
Substance Use Disorders ◽  
Related Factors ◽  
Substance Abuse Treatment Centers ◽  
The Mean ◽  
Abuse Treatment

Abstract Background Substance-Related Disorders are among the most common social problems caused by using legal and illegal substances. Therefore, this study aimed at determining the quality of life (QoL) and its related factors among women with substance use disorders referring to substance abuse treatment centers in Hamadan, west of Iran. Methods This cross-sectional study was carried out on 120 Iranian female substance users recruited through the census sampling method in 2018. Data collection tools consisted of demographic characteristics and QoL assessment (SF-36). Data were analyzed using SPSS-16 via one-way analysis of variance (ANOVA) and chi-square tests. Results The mean age of the participants was 33.2 ± 12.1 years and the mean score of their total QoL was 35.35 ± 13.5. The results of multiple linear regression analysis indicated that using methamphetamine (β =  − 6.62) was the predictor of QoL in women. Moreover, there was a significant association between QoL and age (p < 0.001), educational level (p = 0.011), and age at first use (p < 0.001). Conclusion According to the results, the participants’ QoL was found to be at an unsatisfactory level. So, it is essential to implement educational help-seeking behavior for treatment and effectiveness educational, as well as holding mental health intervention, school-based substance abuse prevention, and harm reduction programs of substance use. This is especially important in adolescents, young, low-educated, early drug use, and methamphetamine user women, as it may increase the QoL

scholarly journals Understanding the Drivers of Mobility during the COVID-19 Pandemic in Florida, USA Using a Machine Learning Approach

2021 ◽  
Vol 10 (7) ◽  
pp. 440
Author(s):  
Guimin Zhu ◽  
Kathleen Stewart ◽  
Deb Niemeier ◽  
Junchuan Fan
Keyword(s):  
Race And Ethnicity ◽  
Learning Approach ◽  
Mobility Patterns ◽  
Random Forest Regression ◽  
Related Factors ◽  
Machine Learning Approach ◽  
The Mean ◽  
Case Data ◽  
Staying At Home ◽  
Very High

As of March 2021, the State of Florida, U.S.A. had accounted for approximately 6.67% of total COVID-19 (SARS-CoV-2 coronavirus disease) cases in the U.S. The main objective of this research is to analyze mobility patterns during a three month period in summer 2020, when COVID-19 case numbers were very high for three Florida counties, Miami-Dade, Broward, and Palm Beach counties. To investigate patterns, as well as drivers, related to changes in mobility across the tri-county region, a random forest regression model was built using sociodemographic, travel, and built environment factors, as well as COVID-19 positive case data. Mobility patterns declined in each county when new COVID-19 infections began to rise, beginning in mid-June 2020. While the mean number of bar and restaurant visits was lower overall due to closures, analysis showed that these visits remained a top factor that impacted mobility for all three counties, even with a rise in cases. Our modeling results suggest that there were mobility pattern differences between counties with respect to factors relating, for example, to race and ethnicity (different population groups factored differently in each county), as well as social distancing or travel-related factors (e.g., staying at home behaviors) over the two time periods prior to and after the spike of COVID-19 cases.

Delayed post-hypoxic leukoencephalopathy: Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s839-s839 ◽  
Author(s):  
M. Solerdelcoll Arimany ◽  
M. Garriga ◽  
E. Parellada
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Brain Mri ◽  
Clinical History ◽  
Good Prognosis ◽  
Mri Findings ◽  
The Mean ◽  
Competing Interest ◽  
Weighted Sequences ◽  
Direct Toxicity ◽  
Progressive Cognitive Impairment

IntroductionDelayed post-hypoxic leukoencephalopathy (DPHL) is an underrecognized syndrome of delayed demyelination, where patients manifest neuropsychiatric symptoms after a period of 2–40 days of apparent recovery from a cerebral hypo-oxygenation episode.ObjectivesWe report a case of a patient who successfully recovered from an overdose of heroin, but then suffered a delayed abrupt neurological deterioration.AimsTo improve assessment and recognition of DPHL.MethodsAn adequate retrospective collection of clinical data and nonsystematic review of the literature was performed.ResultsA 43-year-old male with schizoaffective disorder who attempted suicide with an overdose of heroin, was successfully revived and return to his previously mental status, but 3 weeks after, he abruptly developed progressive cognitive impairment with akinetic mutism and ataxia. He was admitted to our acute psychiatric unit after brain CT and chemistry analyses were unremarkable. Brain MRI showed diffusely symmetric hyperintensity in the white matter (WM), pronominally the periventricular WM, on FLAIR and T2 weighted sequences. At 16 weeks postoverdose, he presented improvement both cognitive and motor symptoms, lasting deficits in frontal-executive functions.DiscussionDPHL is characterized by similar clinical and neuroimaging features regardless of the initial insult. The mean lucid interval coincides with the replacement half-life for myelin related lipids and proteins. Prolonged mild-to-moderate hypo-oxygenation of WM is thought to disrupt myelin turnover. It appears probable that these were responsible for DPHL in our patient rather than a direct toxicity.ConclusionDPHL can be diagnosed when clinical history, laboratory assessments and MRI findings are concordant. DPHL requires extensive support care and carries a relatively good prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Zip Code-Related Income Disparities in Patients with Colorectal Cancer

2021 ◽  
pp. 000313482110234
Author(s):  
Yasmeen Z. Qwaider ◽  
Naomi M. Sell ◽  
Chloe Boudreau ◽  
Caitlin E. Stafford ◽  
Rocco Ricciardi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Income Group ◽  
Tertiary Hospital ◽  
Lower Proportion ◽  
Stage Iii ◽  
Median Income ◽  
Lower Income ◽  
Income Disparities ◽  
The Mean ◽  
Zip Code

Introduction Screening and early detection reduce morbidity and mortality in colorectal cancer. Our aim is to study the effect of income disparities on the clinical characteristics of patients with colorectal cancer in Massachusetts. Methods Patients were extracted from a database containing all surgically treated colorectal cancers between 2004 and 2015 at a tertiary hospital in Massachusetts. We split patients into 2 groups: “above-median income” and “below-median income” according to the median income of Massachusetts ($74,167). Results The analysis included 817 patients. The above-median income group consisted of 528 patients (65%) and the below-median income group consisted of 289 patients (35%). The mean age of presentation was 64 ± 15 years for the above-median income group and 67 ± 15 years for the below-median income group ( P = .04). Patients with below-median income were screened less often ( P < .001) and presented more frequently with metastatic disease ( P = .02). Patients with above-median income survived an estimated 15 months longer than those with below-median income ( P < .001). The survival distribution was statistically significantly different between the groups for stage III disease ( P = .004), but not stages I, II, or IV ( P = 1, 1, and .2, respectively). For stage III disease, a lower proportion of below-median income patients received chemotherapy (61% vs. 79%, P = .002) and a higher proportion underwent nonelective surgery (5% vs. 2%, P = .007). Conclusions In Massachusetts, patients with colorectal cancer residing in lower income areas are screened less, received adjuvant chemotherapy less, and have worse outcomes, especially when analyzing those who present with stage III disease.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

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