A clinical evaluation of the oral and dental complications of sickle cell disease in Nigerians was carried out in 37 consecutive patients with homozygous sickle cell disease Hb-SS (Sicklers) compared to a control group of 24 persons with normal haemoglobin Hb-AA (control group) matched for age and sex. The significant abnormalities found in sicklers included intrinsic opacity of the teeth in 67.5% of sicklers compared to 28.83% in the control group; malocclusion of the teeth with over-jet and over-bite in 35% of sicklers compared to 16.66% in the control group; dental caries is present in 35.13% of sicklers which was less than its occurrence in 54% of the control group due to widespread avoidance of sweets by most local sicklers. Diastemata (gaps between the teeth) was present in approximately equal frequency in sicklers (27%) and control group (25%). In view of the aesthetic and medical implications of these abnormalities, it is recommended that sicklers should receive regular dental check-up with a view to ameliorating or preventing these complications by prophylactic measures including the use of orthodontic appliances such as braces, etc. The above findings are discussed in relation to the other complications of sickler cell disease in other organs of the body.
Comparisons of marrow cellularity determinations in needle biopsy sections, aspirated smears of marrow particles, and aspirated clot sections were made using the point-counting and standard visual methods of measurement. Good correlations of cellularity between biopsies and smears were obtained with the point-counting method. This occurred with either single- or multiple-observer measurements, and differed from the wide observer-to-observer variation obtained in the other comparisons. Although the optimal method for cellularity measurements is point counting by biopsy sections, the findings indicate that aspirated smears of marrow particles can be a suitable substitute for needle biopsy sections when point counting is used. This would be particularly useful in clinical settings necessitating frequent cellularity assessments. The results also show that the standard visual method of cellularity measurement is satisfactory when specimens are evaluated by one observer. The point-counting method of measurement, although the most accurate, is not as reproducible among observers as previously considered.
Marrow iron was assessed in needle biopsy sections and in simultaneously obtained aspirated smears and aspirated clot sections from 251 patients. Significantly different amounts of stainable iron were observed in needle biopsy sections and aspirated smears in 15% of the specimens. The usual difference consisted of significantly less stainable iron in needle biopsy sections as compared to the aspirated smears (13%). Of clinical importance was the finding of absent stainable iron in 8% of the needle biopsy sections, in contrast to the definite deposits observed in the corresponding aspirated smear. Of similar interest was the observation that 6% of the needle biopsy sections had significantly less stainable iron than corresponding hemosiderotic smears. The amounts of stainable iron in needle biopsy sections were similar to the amounts observed in the corresponding aspirated clot sections. Evaluation of marrow iron using needle biopsy sections as well as aspirated clot sections differs from results observed in aspirated smears and could be a source of significant error in the assessment of iron stores.
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