Good Dental Health Essential in Sickle Cell Anemia, Study Finds
Good oral health is essential in people with sickle cell anemia (SCA), according to a new study from Saudi Arabia that found that several disease-causing bacteria species — including Enterobacteriaceae — were significantly more abundant in a group of patients with poorer dental health than in those with better oral care.
“A healthy mouth has a balance of bacteria, but inadequate oral health narrows the range of bacteria, resulting in oral dysbiosis, a state in which beneficial bacteria decrease and potentially pathogenic [disease-causing] bacteria increase,” the researchers wrote.
The findings also indicated that patients with low levels of hemoglobin F — a type of hemoglobin normally produced during fetal development — had a significantly higher prevalence of harmful bacteria species than those who had higher levels of the protein.
“Our data further emphasise the importance of routine oral hygiene visits for patients with SCA,” the team wrote, adding, “This is especially important for patients with SCA and low [hemoglobin F], who have a higher probability of hospitalisation and clinical complications compared to patients with SCA and high [hemoglobin F].”
The research’s findings were reported in “Oral microbiota analyses of Saudi sickle cell anemics with dental caries,” a study published in the International Dental Journal.
Examining good versus poor dental health in SCA
Sickle cell disease (SCD) is caused by mutations in the HBB gene that lead to the production of a faulty version of hemoglobin, the protein in red blood cells that is responsible for carrying oxygen through the body. This faulty version is called hemoglobin S.
People with sickle cell anemia or SCA, the most common and often the most severe form of SCD, have two faulty gene copies encoding hemoglobin S.
Complications of dental caries or tooth decay, including acute pain, are often observed in patients with SCA — and have been associated with poor quality of life.
In a healthy mouth, different bacteria species co-exist in a balanced ratio. However, in cases of inadequate oral health, the number of beneficial bacteria decreases, while that of potentially harmful ones increases. This can lead to dental caries, which often result in cavities and other oral health problems.
“Although ample evidence indicates a causative correlation between the disruption of the oral [bacteria] and dental caries, the effect in SCA has not been investigated,” the researchers wrote.
Now, a team from the Netherlands and Saudi Arabia conducted a study to examine oral bacteria composition in people with SCA. Their aim was to compare bacteria species in patients with a high decayed, missing, and filled permanent teeth (DMTF) index — a measure of dental health — compared with others who had a low index.
In addition, they evaluated the effect of hemoglobin F levels on bacterial composition by comparing the profiles of patients with low and high levels of the protein. Fetal hemoglobin or hemoglobin F is considered a major modulator of disease severity in SCA.
This type of hemoglobin normally is found in fetuses and newborn babies, but is typically replaced by another hemoglobin variant after birth. However, hemoglobin F is more effective at transporting oxygen than its adult counterpart, and may, therefore, help to counteract the harmful effects of hemoglobin S on blood flow and oxygen transport.
In some individuals, the levels of hemoglobin F remain relatively high during childhood, and only start to decline later on in life, rather than immediately after birth.
High levels of Enterobacteriaceae bacteria found
This new study was conducted in the Eastern Province of Saudi Arabia, where the disease is highly prevalent. It included 100 patients, ages 5–12, from whom saliva was collected.
Among the patients, 27 had high dental caries — reflected by a high DMTF index of five points or more — and 73 had low dental caries, indicated by a low DMTF index of four points or fewer.
The research team identified 416 bacteria species in the patients’ samples. When analyzing their prevalence, seven were found to be significantly more abundant in patients with a high DMTF index than in those with a low index.
In addition, eight bacteria species were found to be significantly more prevalent in patients with low hemoglobin F levels compared with those with high levels of the protein.
In particular, the Enterobacteriaceae bacteria species, which have been associated with severe infections and high rates of antibiotic resistance, were found in great abundance in both patient groups, being the most significantly abundant bacteria species among those with low levels of hemoglobin F.
“It has been suggested that the presence of the Enterobacteriaceae species in the oral cavity is favoured when an individual’s immunity is compromised,” the researchers wrote, adding that “patients with SCA are immunocompromised.”
Overall, these findings indicate that Saudi SCA patients with poorer dental health and low levels of hemoglobin F have a higher predominance of harmful bacteria in their mouth.
Our data further emphasise the importance of routine oral hygiene visits for patients with SCA.
“Our results provide a valuable addition to the global microbiome reference data set in an underexamined community,” the researchers wrote, adding, “These efforts are essential and warranted given the scarcity of [bacteria composition] data in Middle Eastern populations.”
Nevertheless, a study with a large sample size evaluating how oral bacterial species can relate to dental caries in SCA patients is required, the team noted.
The researchers said their findings indicate the important of good dental health in people with sickle cell anemia, given that the bacteria species otherwise found “are thought to drive the development and progression of dental caries.”
WHO advisers to consider whether obesity medication should be added to Essential Medicines List
Advisers to the World Health Organization will consider next month whether to add liraglutide, the active ingredient in certain diabetes and obesity medications, to its list of essential medicines.
The list, which is updated every two years, includes medicines “that satisfy the priority health needs of the population,” WHO says. “They are intended to be available within the context of function health systems at all times, in adequate amounts in the appropriate dosage forms, of assured quality and at prices that individuals and the community can afford.”
The list is “a guide for the development and updating of national and institutional essential medicine lists to support the procurement and supply of medicines in the public sector, medicines reimbursement schemes, medicine donations, and local medicine production.”
The WHO Expert Committee on the Selection and Use of Essential Medicines is scheduled to meet April 24-28 to discuss revisions and updates involving dozens of medications. The request to add GLP-1 receptor agonists such as liraglutide came from four researchers at US institutions including Yale University and Brigham and Women’s Hospital.
These drugs mimic the effects of an appetite-regulating hormone, GLP-1, and stimulate the release of insulin. This helps lower blood sugar and slows the passage of food through the gut. Liraglutide was developed to treat diabetes but approved in the US as a weight-loss treatment in 2014; its more potent cousin, semaglutide, has been approved for diabetes since 2017 and as an obesity treatment in 2021.
The latter use has become well-known thanks to promotions from celebrities and on social media. It’s sold under the name Ozempic for diabetes and Wegovy for weight loss. Studies suggest that semaglutide may help people lose an average of 10% to 15% of their starting weight – significantly more than with other medications. But because of this high demand, some versions of the medication have been in shortage in the US since the middle of last year.
The US patent on liraglutide is set to expire this year, and drugmaker Novo Nordisk says generic versions could be available in June 2024.
The company has not been involved in the application to WHO, it said in a statement, but “we welcome the WHO review and look forward to the readout and decision.”
“At present, there are no medications included in the [Essential Medicines List] that specifically target weight loss for the global burden of obesity,” the researchers wrote in their request to WHO. “At this time, the EML includes mineral supplements for nutritional deficiencies yet it is also described that most of the population live in ‘countries where overweight and obesity kills more people than underweight.’ “
WHO’s advisers will make recommendations on which drugs should be included in this year’s list, expected to come in September.
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“This particular drug has a certain history, but the use of it probably has not been long enough to be able to see it on the Essential Medicines List,” Dr. Francesco Blanca, WHO director for nutrition and food safety, said at a briefing Wednesday. “There’s also issues related to the cost of the treatment. At the same time, WHO is looking at the use of drugs to reduce weight excess in the context of a systematic review for guidelines for children and adolescents. So we believe that it is a work in progress, but we’ll see what the Essential Medicines List committee is going to conclude.”
Some pediatric surgeries may be postponed as pediatric ICU faces strain: Shared Health
Re-emerging levels of respiratory illness have caused increased patient numbers at the HSC Children’s pediatric intensive care unit over the last week, and some non-urgent procedures may be postponed, Shared Health says.
On Thursday morning, there were 17 pediatric patients in the intensive care unit, and a considerable number of which were already experiencing health issues that were aggravated by respiratory illness. The unit’s normal baseline is nine, Shared Health said in a Thursday media release.
The release said patient volumes at the children’s emergency department are stable but more children with flu-like symptoms have been recorded coming in over the last two weeks, going from a low of 22 in mid-March to 47 on Wednesday.
A variety of respiratory illnesses are spreading through the community and have contributed to the increased level of patients in the pediatric intensive care unit, according to Shared Health.
Meanwhile, the number of patients in the neonatal intensive care unit was at 51 on Thursday morning, which is slightly above the unit’s normal baseline capacity of 50.
Ten staff are being temporarily reassigned to the pediatric intensive care unit to deal with the increased level of patients, the release said.
Some staff are being pulled from the pediatric surgical and recovery units, which means non-urgent procedures may be postponed due to the reassignments, Shared Health said.
Families of patients impacted by the postponements will be contacted, they said, and all urgent and life-threatening surgeries will go unhindered.
Families can protect their children from respiratory illnesses by limiting their contact with people exhibiting cold-like symptoms, washing their hands frequently and staying up to date on vaccinations, Shared Health said.
Patient volumes increased last month
While overall wait times at emergency and urgent care centres were stable in February, Shared Health said daily patient volumes in the province went up.
The daily average of patients seeking care was 750 last month, which is an increase from 730.4 in January, according to a separate Thursday news release.
The average length of stay for patients in emergency or urgent care units to be transferred to an inpatient unit went down to 21.77 hours last month, which is an improvement from 22.5 hours in January, the release said.
The overall number of people who left without being seen went down last month, from 13 per cent in January to 12.1 per cent in February, according to Shared Health. It also decreased at the HSC emergency department, from 25 per cent in January to 23.4 per cent last month.
Shared Health is reminding Manitobans to continue to call 911 in case of an emergency, and said the sickest and most injured patients will remain their priority.
Respiratory Outbreak Over: Southbridge Pinewood – Kingfisher and Sandpiper Units
March 30, 2023 – The Thunder Bay District Health Unit (TBDHU) and Southbridge Pinewood confirm that the respiratory outbreak on Kingfisher and Sandpiper Units, located at 2625 Walsh St. E, has been declared over. All outbreak restrictions have been lifted.
TBDHU recommends the public refrain from visiting hospitals, long-term care facilities and other high risk settings when feeling unwell to avoid spreading infections to those most vulnerable and at higher risk of severe outcomes.
The Health Unit reminds the public that they can prevent getting and spreading infections by:
- Staying at home when sick.
- Wearing a well-fitted mask in indoor spaces, especially when around vulnerable people or when recovering from illness.
- Keeping up-to-date with influenza and COVID-19 vaccinations.
- Washing hands often, for at least 20 seconds with soap and warm water, or by using an alcohol-based hand sanitizer.
- Covering coughs/sneezes with the upper sleeve if no tissue is available.
- Being familiar with the Ontario screening tool, to self-assess and know what to do next.
For more information on current outbreaks, please visit the following link: https://www.tbdhu.com/outbreaks.
For more information – TBDHU Media: email@example.com
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