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PubMed2005

Prevalence of fractures among the Thalassemia syndromes in North America.

Historically, fractures are cited as a frequent problem in patients with Thalassemia prior to optimization of transfusion and chelation regimens. The aim of this study was to determine the prevalence of fractures in a contemporary sample of North American patients with Thalassemia. The North American Thalassemia Clinical Research Network (TCRN) database registry was used to gather historical data on 702 patients with common alpha and beta-Thalassemia diagnoses including Thalassemia Major (TM), Intermedia (TI), E/Beta, homozygous alpha Thalassemia (AT), Hemoglobin H disease (HbH) and HbH with Constant Spring (HbH/CS), who consented to a medical record chart review. Bone mineral density (BMD) measurements by DXA were available for review in a subgroup of patients (n = 312). The overall fracture prevalence among all Thalassemia syndromes was 12.1%, equally distributed between females (11.5%) and males (12.7%). Fractures occurred more frequently in TM (16.6%) and TI (12.2%) compared to E/Beta (7.4%) and alpha (2.3%). Prevalence increased with age (2.5% ages 0-10 years, 7.4% ages 11-19 years, 23.2% ages >20 years) and with use of sex hormone replacement therapy (SHRT) (P < 0.01). On average, BMD Z and T scores were 0.85 SD lower among patients with a history of fractures (mean Z/T score -2.78 vs. -1.93, 95% CI for the difference -0.49 to -1.22 SD, P = 0.02). Presence of other endocrinopathies (i.e. hypothyroidism, hypoparathyroidism and diabetes mellitus), anthropometric parameters, heart disease or hepatitis C were not significant independent predictors of fractures. These data indicate that fractures remain a frequent complication among the aging patients with both TM and TI beta-Thalassemia. However, the fracture prevalence has improved compared to published reports from the 1960s to 1970s. In addition, children with Thalassemia appear to have low fracture rates compared to the general population.

Adolescent↗
PubMed2004

How do climate fluctuations affect persistent organic pollutant distribution in North America? Evidence from a decade of air monitoring.

Interannual variations of persistent organic pollutant (POP) air concentrations from the Great Lakes region and the Arctic during the 1990s are strongly associated with atmospheric low-frequency fluctuations, notably the North Atlantic Oscillation (NAO), the El Niño-Southern Oscillation (ENSO), and the Pacific North American (PNA) pattern. This suggests interactions between climate variation and the global distribution of POPs. Atmospheric concentrations of hexachlorocyclohexanes (HCHs), hexachlorobenzene (HCB), and several lighter polychlorinated biphenyls (PCBs) measured around the Great Lakes basin increased during the positive phases of NAO and ENSO in the spring. This implies that anomalous high air temperatures associated with NAO and ENSO enhance volatilization of POPs from reservoirs on the Earth's surface accumulated in the past. These compounds are then available for transport from source regions to more pristine regions such as the Arctic under favorable flow patterns associated with global climate variations.

Air Movements↗