BackgroundAdrenal, thyroid, and parathyroid gland hormonal changes are recognized in children with homozygous (HbSS) sickle-cell anemia (SCA), but are not clear in adult patients with SCA.AimTo assess the metabolic and endocrine abnormalities in adult patients with SCA and evaluate left ventricular (LV) systolic and diastolic functions compared with patients with no SCA and further study the relationship between serum levels of cortisol, free thyroxine (T4), and testosterone with serum ferritin.Materials and methodsThe study was conducted on 82 patients with adult HbSS SCA compared with a sex- and age-matched control group. The serum levels of cortisol, parathyroid hormone (PTH), testosterone, thyroid-stimulating hormone (TSH), and free T4 were compared. Blood levels of hemoglobin, reticulocyte count, lactate dehydrogenase (LDH), calcium, alkaline phosphatase (ALP), vitamin D3, and ferritin were also compared. Pulsed Doppler echo was performed to evaluate the LV mass, wall thickness, and cavity dimensions with diastolic filling velocities of early (E) and atria (A) waves. Biometric data were analyzed as mean ± standard deviation between the two groups. Multiple regression analysis was performed between serum levels of ferritin as independent variable and testosterone, cortisol, and thyroid hormones.ResultsA total of 82 adult patients with HbSS SCA were enrolled who had a mean age of 21±5.7 years, with 51 males (62%). Patients with SCA compared with the control group had significantly lower hemoglobin, body mass index, cortisol, vitamin D3, testosterone, and T4. Furthermore, there were significantly high levels of reticulocyte count, PTH, TSH, ferritin, LDH, ALP, and uric acid. The incidence of subclinical hypothyroidism and adrenal insufficiency was 7% and 4.8%, respectively, with hypogonadism 9.8% and vitamin D3 deficiency 61%. There were inverse relationships between ferritin as independent variable and serum levels of testosterone, T4, and cortisol, with regression coefficients of −0.49 (P<0.001), −0.33 (P<0.001), and −0.11 (P<0.92), respectively.ConclusionPatients with adult SCA had a high prevalence of in vivo hypoadrenialism (4.8%), hypogonadism (9.8%), and hypothyroidism (7%). There were significant inverse relationships between serum ferritin as independent variable and cortisol, testosterone, and T4. Pulsed Doppler echocardiography showed increased LV mass, with a restrictive LV diastolic pattern suggestive of diastolic dysfunction.

Background: Anemia in children is a frequent problem. Worldwide, it affects 25% of the population ranging from 64.6% in Africa to 3.4% in North America. Iron deficiency is the main cause of anemia. Even though studies indicate that the percentage of anemia among preschool children is decreasing in Bahrain, it is still considered high and needs immediate intervention. Objective: To estimate the prevalence of anemia among nine-month-old infants attending child screening services in local health centers during the month of July 2012, and to examine the correlation between hemoglobinopathies and anemia in mothers during pregnancy and anemia in infants. Methods: This was a descriptive, retrospective study. The records of 1,378 nine-month-old infants attending mother and child care for child screening services in all local health centers during July 2012 were studied. Results: 1,230 infants (89.3%) had hemoglobin level test done. 498 cases (40.5%) were anemic, mainly of the mild type; 208 anemic children (41.8%) had no hemoglobinopathies, 140 (28.1%) had hemoglobinopathies and 150 (30.1%) were not tested for hemoglobinopathies. The commonest type of hemoglobinopathy was alpha-thalassemia, 91 (18.5%), followed by sickle cell trait, 58 (11.6%). 224 of the mothers of anemic infants (45%) had no anemia and 218 (43.8%) were anemic. Overall, 338 mothers with anemic infants (76.4%) had no hemoglobinopathies. Conclusion: Anemia among infants is decreasing in the Kingdom of Bahrain generally and decreasing with age specifically but it is still considered a severe public health problem. Most of the cases of anemia among nine-month-old children are due to iron deficiency anemia and one-fifth of the cases are hemoglobinopathies. It is recommended that iron drops be supplied as daily dietary supplementation at weaning and to be continued for one year for those with negative sickle cell disease and thalassemia test at birth.

BackgroundInflammatory markers are increased during vaso-occlusive crisis (VOC) in adult patients with sickle cell anemia (SCA), but this is not clear in clinical steady state.AimThe present study aims to establish the frequency and intensity of bone pain episodes in adult patients with SCA in clinical steady state and to determine the correlation between different inflammatory markers, other variables including QT dispersion (QTd) and pain frequency and intensity in SCA.Patients and methodsPatients were classified into two groups: group 1, those with more than three hospital admissions in the last 6 months, and group 2, those with no hospital admission. Pearson correlation between variables such as body mass index (BMI), level of tumor necrosis factor (TNF-α), interleukin-1 (IL-1), C-reactive protein (CRP), hemoglobin (Hb), reticulocyte count, white blood cell count (WBC), ferritin, lactate dehydrogenase (LDH), parathormone (PTH), vitamin D3 (25-OH cholecalciferol) and bone pain frequency with severity was evaluated.ResultsForty-six patients were enrolled in this study with a mean age of 18.47±5.78 years, with 23 patients in each group. Vitamin D3 and Hb were lower (17.04±5.77 vs 37.59±4.83 ng/L, P<0.01 and 7.96±0.3 vs 8.44±0.27 g/dL, P<0.01, respectively); the inflammatory markers showed significantly higher level of TNF-α, IL-1 and CRP (56.52±5.43 pg/ml, 44.17±4.54 pg/ml and 3.20±0.72 mg/L, respectively, P<0.05); WBC, LDH and reticulocyte count were also significantly higher and the QTd was higher (45.0±2.22 vs 41.55±0.8 ms, P<0.05) in group 1 when compared with group 2. Pearson correlation coefficient showed significant positive correlation between serum level of TNF-α and bone pain frequency (r=0.414, P<0.005) and serum level of IL-1 (r=0.39, P<0.008).ConclusionThere is a strong positive correlation between TNF-α, IL-1 and WBC and bone pain frequency in steady state in adult patients with SCA. CRP and low hemoglobin had weak positive correlation. QTd was significantly longer in patients who had hospitalizations with VOC.

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