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      Mortality by sickle cell disease in Brazil

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          Abstract

          This work aimed to characterize mortality by sickle cell disease in Brazil. The MEDLINE electronic database was searched using the terms ‘mortality’ and ‘sickle cell disease’ and ‘Brazil’ for articles published in the last five years aiming to provide a current analysis of the subject in question. Eight studies on mortality by sickle cell disease were carried out in the Brazilian states of Maranhão, Bahia, Minas Gerais, Rio de Janeiro and Mato Grosso do Sul. The majority of the deaths occurred in patients with sickle cell anemia, which is the most common genotype and causes the most severe clinical manifestation of the disease. In summary, there are few published studies on mortality related to sickle cell disease in Brazil, and most are from the state of Minas Gerais. This study emphasizes the importance of developing more studies on sickle cell disease mortality, so that it may be possible to profile gene carriers and give health professionals more data to strategize the delivery of more effective assistance to these individuals. Despite the early diagnosis of sickle cell disease by the Neonatal Screening Program and the use of preventive and therapeutic measures (penicillin, immunization and hydroxyurea), mortality by sickle cell disease on the world stage is still significant.

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          The effect of prolonged administration of hydroxyurea on morbidity and mortality in adult patients with sickle cell syndromes: results of a 17-year, single-center trial (LaSHS).

          The aim of this prospective study was to evaluate the long-term efficacy and safety of hydroxyurea (HU) in patients with sickle cell disease (SCD). Thirty-four patients with sickle cell anemia (hemoglobin S [HbS]/HbS), 131 with HbS/beta(0)-thal, and 165 with HbS/beta(+)-thal participated in this trial. HU was administered to 131 patients, whereas 199 patients were conventionally treated. The median follow-up period was 8 years for HU patients and 5 years for non-HU patients. HU produced a dramatic reduction in the frequency of severe painful crises, transfusion requirements, hospital admissions, and incidence of acute chest syndrome. The probability of 10-year survival was 86% and 65% for HU and non-HU patients, respectively (P = .001), although HU patients had more severe forms of SCD. The 10-year probability of survival for HbS/HbS, HbS/beta (0)-thal, and HbS/IVSI-110 patients was 100%, 87%, and 82%, respectively, for HU patients and 10%, 54%, and 66%, for non-HU patients. The multivariate analysis showed that fetal hemoglobin values at baseline and percentage change of lactate dehydrogenase between baseline and 6 months were independently predicted for survival in the HU group. These results highlight the beneficial effect of HU, which seems to modify the natural history of SCD and raise the issue of expanding its use in all SCD patients.
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            Aspectos epidemiológicos e sociais da doença falciforme

            A doença falciforme (DF) é uma doença genética frequente. Predomina entre negros e pardos e, no Brasil, a cada ano, nascem 3.500 crianças com DF e 200.000 com traço falciforme. As hemácias com hemoglobina S assumem, em condições de hipóxia, forma semelhante à foice, podendo levar à oclusão dos capilares, provocando lesões teciduais agudas e crônicas de órgãos, quase sempre acompanhadas de dor. Através de visitas domiciliares objetivou-se ampliar o conhecimento dos aspectos epidemiológicos e de enfrentamento da doença. Foram estudados 47 pacientes falcêmicos da cidade de Uberaba (MG), com idade igual ou superior a 18 anos, sendo 78,7% negros, 17% pardos e 4,3% brancos, preponderando o gênero feminino (59,6%). Quanto ao tipo de hemoglobinopatia, 63,8% eram SS, 17% SC e 10,6% β-talassemia. A maioria (74,5%) residia em bairros periféricos; 42,5% tinham o segundo grau completo; 38,2% eram aposentados ou não tinham profissão definida. A renda per capita de 48,9% era de até um salário mínimo e 19,1% não percebiam qualquer rendimento. Quanto aos sentimentos relacionados à doença, 38,3% referiram aceitação, 21,3% revolta, 17% tristeza; 46,8% relatavam, após o diagnóstico, mudança para pior em relação ao trabalho e 31,9% em relação ao lazer. Verificou-se neste estudo que a DF reflete negativamente nas atividades laborais e na qualidade de vida do paciente. Contudo, as dificuldades no enfrentamento da doença, habitação precária, desemprego e/ou trabalho mal remunerado poderiam ser minimizadas com acompanhamento social e psicoterápico adequados, que deveriam ser disponibilizados a todo doente falciforme.
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              Mortality rates and age at death from sickle cell disease: U.S., 1979-2005.

              Improvements in survival for children with sickle cell disease (SCD) during the last 30 years have been well established. Whether similar improvements for adults with the disease have occurred is unknown. We investigated mortality rates for children and adults with SCD. We used the National Center for Health Statistics multiple-cause-of-death files to examine age at death and calculate mortality rates from 1979 to 2005. We examined trends in mortality rates using negative binomial regression, and we examined age at death using t-tests and linear regression. We identified 16,654 sickle cell-related deaths. Mean age at death was significantly different for males (33.4 years, 95% confidence interval [CI] 33.0, 33.7) than for females (36.9 years, 95% CI 36.5, 37.4). In a regression model controlling for gender, the mean age at death increased by 0.36 years for each year of the study. The median age at death in 2005 was 42 years for females and 38 years for males. The overall mortality rate increased 0.7% (p 19 years of age) mortality rate increased by 1% (p<0.001) each year during the time period studied. The pediatric mortality rate decreased by 3% (p<0.001) each year during the time period studied. These data confirm prior findings of a significant decrease in mortality for children with SCD. The mortality rate for adults appears to have increased during the same time period. It seems unlikely that this increase is due merely to an influx of younger patients surviving to adulthood and may reflect a lack of access to high-quality care for adults with SCD.
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                Author and article information

                Contributors
                Journal
                Rev Bras Hematol Hemoter
                Rev Bras Hematol Hemoter
                Revista Brasileira de Hematologia e Hemoterapia
                Sociedade Brasileira de Hematologia e Hemoterapia
                1516-8484
                1806-0870
                21 October 2016
                Jan-Mar 2017
                21 October 2016
                : 39
                : 1
                : 52-56
                Affiliations
                [0005]Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
                Author notes
                [* ] Corresponding author at: Universidade Federal do Triângulo Mineiro (UFTM), Instituto de Ciências Biológicas e Naturais/ICBN, Departamento de Patologia, Genética e Evolução, Disciplina de Genética, Campus I. Praça Manoel Terra, 330, 38015-050 Uberaba, MG, Brazil.Universidade Federal do Triângulo Mineiro (UFTM), Instituto de Ciências Biológicas e Naturais/ICBN, Departamento de Patologia, Genética e Evolução, Disciplina de GenéticaCampus I. Praça Manoel Terra, 330UberabaMG38015-050Brazil alessandratrovo@ 123456hotmail.com
                [1]

                The authors contributed equally to this work.

                Article
                S1516-8484(16)30110-4
                10.1016/j.bjhh.2016.09.008
                5339371
                28270347
                867ce301-10b7-48ca-873f-9354d5af8244
                © 2016 Published by Elsevier Editora Ltda. on behalf of Associaç˜ao Brasileira de Hematologia, Hemoterapia e Terapia Celular.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 15 May 2016
                : 9 September 2016
                Categories
                Review Article

                Hematology
                sickle cell anemia,mortality,neonatal screening,infection,acute chest syndrome
                Hematology
                sickle cell anemia, mortality, neonatal screening, infection, acute chest syndrome

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