SUMMARY. The concentrations of serum calcium, parathyroid hormone (PTH), 25 Hydroxyvitamin D (250HD), and 1,25 Dihydroxyvitamin D (1,25(OH}zD) were determined in 99 Saudi patients with sickle cell disease and in 104 matching healthy controls. Serum calcium and 250HD were significantly lower in the patients, with 140/0 and 12% of them had serum calcium and 250HD concentrations, respectively, below the normal range. PTH was significantly higher in the patients, with 31% having values above the normal range. There was no significant difference between patients and controls in regard to 1,25(OH}zD. There was a significant inverse correlation of 250HD with PTH and a direct correlation of PTH with 1,25(OH}zD. Dietary intake of calcium and vitamin D was adequate in both patients and controls. The results indicate that sickle cell patients have hypocalcaemic tendency associated with supranormal PTH, and imply impaired intestinal absorption of calcium and vitamin D leading to a disturbed calcium metabolism which might contribute to the skeletal changes seen in sickle cell disease.Additional key phrases: diet; sunlight; 25 cholecalciferol; 1,25 cholecalciferol Vitamin D synthesized in the skin and absorbed in the intestine, undergoes metabolic transformations before exerting its effect on target tissues
Background Polyparasitic infection is a possibility in areas where parasites are endemic, especially among children. This study looked at the prevalence of polyparasitic infections among children in the Volta Region of Ghana. Methods This was a cross-sectional study, among 550 primary school children (aged 6–14 years) in 3 districts in the Volta Region. Questionnaires were administered, and blood, stool, and urine samples were collected. Blood samples were screened for Plasmodium falciparum with rapid diagnostic test and microscopy, together with hemoglobin estimation. Stool and urine samples were microscopically examined using wet mount and sedimentation methods to detect intestinal parasites and Schistosoma haematobium, respectively. Pearson χ 2 test was used to evaluate the association between parasitic infections and socioeconomic variables, and multivariate logistic regression to evaluate paired associations among parasites. Results The most prominent infection among the children was P. falciparum (present in 383 children [69.6%]), followed by S. haematobium (57 [10.36%]). There was low prevalence of intestinal protozoa (present in 11 children [2%]), Ascaris lumbricoides (7 [1.27%]), and hookworm (5 [0.91%]). A total of 62 children had polyparasitic infection, with P. falciparum and S. haematobium having significant paired association (both present in 46 children [74.19%]; adjusted odds ratio, 2.45; P = .007). Conclusion The prevalence of polyparasitic infection was low in this study, and significant coinfection was seen with P. falciparum and S. haematobium .
It has previously been reported that in adult patients with sickle-cell anemia the serum phosphate value and the maximum tubular reabsorption of phosphate per liter of glomerular filtrate (TmP/GFR) were significantly higher than in normal controls. This does not appear to have been studied in children with sickle cell anemia (young sicklers) and this prompted us to assess renal phosphate reabsorption in this group of patients. We looked at serum phosphate level and calculated renal phosphate reabsorption (TP/GFR) in children taking random urine and blood samples at the same time and using the formula TP/GFR = Sp – Up × SCr: UCr, in 30 young sicklers all of whom had normal renal function (mean age 7.3 years) and 40 normal matching controls (mean age 6.5 years). The mean serum phosphate value in young sicklers was significantly lower than in controls (4.3 against 5.3 mg/dl) while the mean value of TP/GFR was 4.09 ± 0.74 mg/dl in young sicklers compared to 4.65 ± 0.75 mg/dl in the control group (p = 0.0026). Therefore, the TP/GFR in young sicklers was also significantly lower (p = 0.0026) than in the control group. This may be explained by the high serum level of parathyroid hormone reported previously in patients with sickle cell anemia which is expected to lower phosphate reabsorption (TmP/GFR and TP/GFR are identical in children). The lower serum phosphate value and TP/GFR in younger sicklers seems to be in contrast with the relatively high serum phosphate value and TP/GFR previously reported in adults with sickle cell anemia.
In a 3-year period, eight cases of cerebrovascular accident were seen out of 400 patients with sickle cell disease residing at high and low altitudes of Asir Province of Saudi Arabia. They were all Saudi nationals and comprised five boys and three girls of ages ranging from 3.5 to 9 years. They had varied clinical presentations of their cerebrovascular accident. Cranial computed tomography in seven of them showed abnormality in the region of the middle cerebral circulation. Management and some suggested factors contributing to the occurrence of the cerebrovascular accident are discussed.
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