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June
2023
- Volume 17, Issue 1
Corticosteroids
during acute painful crises of sickle cell diseases
Mehmet Rami
Helvaci 1, Esra Candan 2, Ayse Ceylan 2, Huseyin Sencan 1,
Abdulrazak Abyad 3, Lesley Pocock 4
(1) Specialist of Internal Medicine,
MD, Turkey
(2) Manager of Writing and Statistics, Turkey
(3) Middle-East Academy for Medicine of Aging, MD, Lebanon
(4) medi-WORLD International, Australia
Correspondiing author
Prof Dr Mehmet Rami Helvaci, MD
07400, ALANYA, TurkeyPhone: 00-90-506-4708759
Email: mramihelvaci@hotmail.com
Received: April 2023; Accepted: May
2023; Published: June 2023
Citation: Mehmet Rami Helvaci et al. Corticosteroids during
acute painful crises of sickle cell diseases Middle East Journal
of Nursing 2023; 17(1): 42-53 DOI: 10.5742/MEJN2023.9378033
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ABSTRACT
Background:
Sickle cell diseases (SCD) are severe inflammatory processes
on vascular endothelium, particularly at the capillary level
since the capillary system is the main distributor of hardened
red blood cells (RBC) into the tissues.
Methods:
All patients with the SCD were included.
Results:
The study included 222 males and 212 females with similar
ages (30.8 vs 30.3 years, p>0.05, respectively). Disseminated
teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%,
p<0.001), cirrhosis (8.1% vs 1.8%, p<0.001), leg ulcers
(19.8% vs 7.0%, p<0.001), digital clubbing (14.8% vs 6.6%,
p<0.001), coronary heart disease (18.0% vs 13.2%, p<0.05),
chronic renal disease (9.9% vs 6.1%, p<0.05), chronic obstructive
pulmonary disease (25.2% vs 7.0%, p<0.001), and stroke
(12.1% vs 7.5%, p<0.05) were all higher but not acute chest
syndrome (2.7% vs 3.7%), pulmonary hypertension (12.6% vs
11.7), deep venous thrombosis and/or varices and/or telangiectasias
(9.0% vs 6.6%), and mean age of mortality (30.2 vs 33.3 years)
in males (p>0.05 for all).
Conclusion:
Although the hardened RBC-induced capillary endothelial
damage is present in whole body even at birth, severe exacerbations
during additional stresses are called as acute painful crises.
An increased basal metabolic rate, exaggerated sickling, diffuse
capillary endothelial damage, exaggerated capillary endothelial
inflammation and edema, generalized tissue hypoxia, and multiorgan
insufficiencies may be the main causes of mortality during
the crises. Although rapid RBC supports are the main treatment
option, corticosteroids should also be added to decrease severity
of endothelial inflammation and edema, and to prevent tissue
hypoxia and multiorgan insufficiencies during such crises.
Key words:
Sickle cell diseases, acute painful crises, capillary inflammation,
capillary edema, corticosteroids, metabolic syndrome, atherosclerosis
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