Common Reason For Consultation Research Articles

Differences between parents’ and paediatricians’ perceptions of mild respiratory infections in childhood: contrast study

IntroductionMild respiratory infections are a common reason for consultation in paediatrics, both in the emergency department and in primary care clinics. These conditions, mostly viral and self-limiting, have a significant impact on the healthcare system, school and work absenteeism, and family routines. Despite being common and banal illnesses from a medical perspective, they involve a significant concern in families. The main objective of the contrast study was to compare the perceptions of parents and paediatricians regarding mild respiratory infections in childhood and their impact on family conciliation.Materials and methodsTwo online, cross-sectional surveys were conducted among Spanish paediatricians and parents with children aged 6 months to 12 years, involving 504 paediatricians and 1,447 families, with questions on attitudes towards visits to the paediatric consultation, care burden of minor pathologies, work, and family conciliation, and treatment and prevention of these illnesses.ResultsResults showed significant differences in paediatricians’ and parents’ perceptions in many aspects. According to 34.5% of paediatricians and 27% of parents, families regularly go to the paediatrician without a scheduled visit. Only 4% of parents report having self-medicated their child, while paediatricians raise this percentage significantly to 48%. Regarding the question: “it is normal for a child to have an average of 4 colds a year,” only 25.5% of the surveyed families “strongly agree” unlike to 70.2% of paediatricians. 72.8% of paediatricians “strongly agree” with: “in my opinion, it is good for children to get sick to improve their immune system” reduced to 45.9% of parents. Consultations for minor pathologies represent a “high workload” for 60.9% of paediatricians, while this opinion is agreed by only 18.9% of the parents.ConclusionMild respiratory infections in childhood are perceived differently by paediatricians and parents. While paediatricians perceive them as a common and manageable phenomenon, parents tend to show higher concern and demand for medical attention. This study underlines the need to improve communication between paediatricians and parents to align perceptions, optimise the use of the health system resources, and improve the efficiency in the management of these common paediatric illnesses.

Extravertebral low back pain: a scoping review

BackgroundLow back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered.MethodsA systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included.ResultsThe literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes.DiscussionPrior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient.ConclusionThe differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.

An integrated mental health video consultations model for patients with somatic symptom disorder in primary care: The randomized VISION pilot trial

ObjectiveSymptoms of somatic symptom disorder (SSD) are one of the most common reasons for consultations in primary care. However, specialized psychological services are mostly unavailable. This pilot trial aimed to determine the feasibility, acceptability, and safety of the integrated mental health video consultations VISION model for patients with SSD in primary care. MethodsWe conducted a parallel group, randomized controlled pilot trial involving fifty-one patients with SSD from ten primary care practices in Germany, who we randomized to the VISION model or enhanced treatment-as-usual (eTAU). The VISION model comprised five video consultations which featured diagnostic clarification, psychoeducation (acknowledging and legitimizing of symptoms), and brief psychological therapy. eTAU included training primary care practice teams on the DSM-5 concept of SSD guideline recommendations for its treatment in primary care. We assessed feasibility as the primary outcome at 6-months, measuring efficiency of recruitment, intervention acceptability, safety. ResultsRecruitment was efficient reflected in an overall recruitment yield (number randomized per number screened) of 55% (51/92) and a consent rate (number randomized per number eligible) of 94% (51/54). Acceptability of the intervention was high with 98% (123/125) of the video consultations conducted as planned. No serious adverse events were reported in either group. ConclusionAn integrated mental health video consultations VISION model for patients with SSD presenting to primary care is feasible, acceptable, and safe. Potential clinical effectiveness of the model should be evaluated in confirmatory trial putting the multifaceted approach tailored to the individual patient with SSD directly into primary care practice. Trial registrationThe trial protocol was registered at German Clinical Trials Register (number: DRKS00026075, https://www.drks.de).

Tinea Capitis at Ibn Sina Hospital in Rabat, Morocco: Epidemiological and Etiological Study Over 25 Years (From 1997 to 2021).

Introduction/Objective In Morocco, tinea capitis is a common reason for consultation, especially in children. Our study aimed to determine the epidemiology of tinea capitis in the Central Laboratory of Parasitology and Mycology at the Ibn Sina University Hospital Center (UHC) in Rabat. Materials and methods This is a retrospective study conducted over 25 years (from 1997 to 2021). It included 247 patients with lesions suggestiveof tinea capitis, who underwent a mycological examination. Results Among 594 requests for the diagnosis of tinea capitis, 247 cases were positive. A clear predominance of children (86.23%; n=213) as compared to adults (13.77%; n=34) was observed. The sex ratio (M/F) was 1.77. Hair parasitism was mainly dominated by the pure endothrix type 54.47% (n=122). The two most frequently isolated species were Trichophyton violaceum(51.24%; n=125)and Microsporum canis(36.06%; n=88). In children, these two species represented 47.42% (n=101) and 41.31% (n=88), respectively. In adults, Trichophyton violaceum was the predominant species, accounting for 77.42% (n=24); in females, it was 76.41% (n=68); and Microsporum canis was predominant in males (50.32%; n=78). Conclusion The epidemiology of this condition is in a constant state of flux, influenced by various lifestyle factors. Our research unveiled a notable upward trend in zoophilic species over the 25-year study period, while conversely, anthropophilic species demonstrated a discernible decline.

Abstract 924: Patterns of specialty referral in cancer patients treated with immunotherapy regimens

Abstract Background: Specialty referral rates have been steadily increasing, as much as 94% within a 10-year period (1). Previous studies have shown the benefits of specialty referral in oncology management in specific populations such as lung cancer patients (2). However, there have yet to be larger-scale studies on general trends in specialty referral in oncology. In particular, patients on immune checkpoint inhibitors frequently develop immune-related adverse events (irAEs) affecting a variety of organ systems and may benefit from specialty care (3). Objectives: To evaluate the patterns of specialty referral in patients treated with immune checkpoint inhibitors and identify referral patterns that affect patient outcomes. Methods: This was a retrospective study of all specialty referral for patients on an immunotherapy regimen from 6/1/2022-6/1/2023 at a single-institution cancer center. The specialties consulted included cardiology, dermatology, endocrinology, gastroenterology, infectious disease, neurology, pulmonology, and nephrology. Results: In total, there were 5,602 patients on an immunotherapy regimen, of whom 3,519 patients (62.8%) were referred to a specialist. Of these patients, 2,017 (57.3%) attended a specialist appointment. A majority of the patients were male (n=1038, 51.5%), had a mean age of 64.1 years (SD=13.8) at initial consult, and were White/non-Hispanic (n=1414, 70.1%). The mean and median number of consults per patient were 1.7 (SD=1.3) and 1 (IQR=1), respectively. The maximum number of consultations for a patient was 17. Dermatology was the most commonly consulted service (n=841, 25.9%), followed by neurology (n=781, 24.0%), and endocrinology (n=446, 13.7%). For dermatology, the most common reason for consultation was evaluation of a rash (n=500, 59.5%). Dermatology also had the highest ratio of outpatient to inpatient consultations at 10.4 to 1. The next closest service was endocrinology at 3.0 to 1. The pulmonary service had the shortest time between consult request and patient visit (10 days), followed by dermatology (13 days), and gastroenterology (15 days). Prior to their initial consultation, the vast majority of patients (82.6%) were on a single therapy, and the most common single therapy was pembrolizumab (n=1589, 59.2%). The most common combination therapy was ipilimumab plus nivolumab, accounting for 59.3% of combinations. Fifty percent of patients (n=1008) who saw a specialist were able to continue their immunotherapy regimen. Conclusions: There is a range of specialty and multidisciplinary care that is necessary for the management of patients on immunotherapy regimens. Citation Format: Anna Chen, Stephen Dusza, David Faleck, Neil Shah, Mario E. Lacouture. Patterns of specialty referral in cancer patients treated with immunotherapy regimens [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 924.

Enfermedad diverticular

Diverticula are sac-like protrusions that appear in the weak points of the colon wall. They are usually asymptomatic. Diverticular disease develops when symptoms appear. Its etiopathogenesis is likely multifactorial, although it is not fully known. Complicated diverticulosis includes acute diverticulitis, which is the most frequent complication and one of the most common reasons for consultation in emergency departments, and diverticular hemorrhage, one of the most frequent causes of lower gastrointestinal bleeding in our setting. A diagnosis of acute diverticulitis is established through an abdominal computed tomography scan. A diagnosis of hemorrhage is established by performing a full colonoscopy, for which adequate prior preparation of the patient by means of taking an oral laxative solution is recommended. The treatment of acute diverticulitis has classically been based on the use of antibiotics, although current evidence supports a decrease in the use of antibiotic treatment in patients with uncomplicated acute diverticulitis. In this disease, antibiotics must target a polymicrobial etiology consisting mainly of gram-negative and anaerobic bacilli.

Musculoskeletal pain in 13-year-old children: the generation R study.

Musculoskeletal (MSK) pain is a common reason for consultation in general practice and frequently reported in children and adolescents. This study examined the prevalence of MSK pain in 13-year-old children and assessed associations with physical and psychosocial factors. Data from the Generation R Study, a population-based birth cohort, was used. Prevalence and characteristics of MSK pain were assessed, using a pain mannequin, at 13 years of age (N = 3062). Demographics and data on physical activity, sedentary behaviors, previous reported MSK pain, and behavioral problems were extracted from questionnaires. The body mass index (BMI) SD-score was calculated from objectively measured weight and height. A prevalence of 23.3% was found for MSK pain in children of which 87.2% persisted for more than 3 months (ie, chronic), 45.5% experienced pain daily. More physically active children and children with a higher BMI reported MSK pain more frequently compared with non-MSK pain and no pain. The knee was the most often reported location. Children with MSK pain were more likely to have reported MSK pain at 6 years. Multivariable analyses showed significant associations for male sex (OR 0.74, 95% CI 0.56-0.98), high maternal educational (OR 0.69, 95% CI 0.49-0.96), higher BMI (OR 1.19, 95% CI 1.05-1.35), being physically active (OR 1.41, 95% CI 1.03-1.91), and behavioral problems (OR 1.85, 95% CI 1.33-2.59) with the presence of MSK pain. The chronic nature of MSK pain in combination with the relatively high prevalence of MSK pain in this study shows that MSK pain is already an important problem at a young age.

Protocolo diagnóstico del dolor epigástrico agudo

Acute abdominal pain (AAP) is a common reason for consultation in emergency departments and, in up to one quarter of patients, it is located in the epigastrium. AAD encompasses a wide variety of both intra-abdominal and extra-abdominal clinical syndromes which vary in severity. For this reason, a correct early assessment of vital risk and a proper diagnostic approach based on a case history, physical examination, and additional tests are essential.This protocol includes the most important clinical and physical examination features that will allow for making a correct differential diagnosis of acute epigastric pain.

The role of general surgery consultations on patient diagnosis and treatment in the Tertiary Medical Center

Background: The field of general surgery is an important one in medicine. It includes the systems and organs connected to practically every bodily part. Because of this, general surgery is frequently requested for consultation and has a significant role in emergency service applications. The study’s objective is to evaluate general surgery consultations based on their specific attributes. Methods: A retrospective analysis was performed on 814 patients who were consulted at our hospital’s general surgery clinic between January and June 2021. The departments requesting consultation, the reasons for the consultation, the examinations requested before and after the consultation, and the decisions made after the consultation were evaluated. Results: The department that required the most consultation from the general surgery branch was the emergency department with 91.5% the most common reason for consultation is nonspecific abdominal pain with 18.1% has been seen. General surgery consultation in patients presenting with abdominal specific complaints, previously ultrasonography and computed tomography were requested in 88.6% of patients. Conclusion: The fact that physicians request unnecessary consultations and resort to advanced imaging examinations with the reservation of malpractice leads to an increase in both cost and intensity for the health system. Requesting a consultation in conditions where it is more necessary will relieve the intensity of the health system.

Characteristics of older patients in the largest French psychiatric emergency centre.

Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.

Diagnosis and treatment of Müllerian anomalies: Experience at the Fundación HOMI

BackgroundMüllerian anomalies are rare developmental abnormalities. In the pediatric population, they manifest clinically during puberty and may require surgical treatment for symptom management. MethodsRetrospective case series study of children with Müllerian anomalies who were taken to diagnostic or therapeutic procedures by the pediatric surgery service at the Fundación HOMI from January 2018 to October 2022. Statistical analysis was performed calculating measures of central tendency and dispersion. ResultsFifteen patients were included. The most common reason for consultation was abdominal pain in 80 % of the cases. Associated comorbidities were found in 73.3 % of the patients, the most frequent being anorectal malformations (40 %) and renal agenesis (33.3 %). Pelvis MRI was performed in all cases. the most commonly observed finding was imperforate hymen, accounting for 19.8 % of cases. The anomaly was surgically corrected in 86 % of the patients. The median age at the time of surgery was 13 years (IQR 10–14). Reoperation was required in 33.3 %, of which all required vaginoscopy and dilatation. ConclusionsMüllerian anomalies are rare and usually present with nonspecific symptoms, the most frequent being pain. They are usually associated with renal and anorectal anomalies. In this case series, the use of magnetic resonance imaging and vaginoscopy were essential for diagnosis.

Üçüncü Basamak Bir Hastanede Acil Servis Nöroşirurji Konsültasyonları

Objective: To reveal the characteristics of patients needing neurosurgery by examining neurosurgery consultations within the emergency department (ED) admissions of a tertiary academic hospital.
 Method: This is a retrospective, single-centre observational study. Patients admitted to the ED between 01.01.2022 and 31.12.2022 and consulted to the neurosurgery department were identified through the hospital computer system and included in the study. The demographic information of the patients, mode of admission to the ED, the reasons for admission, the time of admission, the number of brain computed tomography (CT) scans, whether they underwent surgery or not, and the mortality results were recorded. 
 Results: A total of 441 neurosurgery consultations were examined. Fall 35.6% (n=157) and traffic accident 16.6% (n=73) were the most common reasons for consultation. It was observed that 92.5% (n=408) of the patients had a brain CT scan, and 19.5% (n=86) had two or more brain CTs. It was determined that 12.7% (n=56) of the patients consulted for neurosurgery were operated on, and 4.1% (n=18) of the patients' hospital admissions resulted in death. Only 53.7% (n=237) of the patients who underwent neurosurgery consultation were discharged from the ED. It was determined that significantly more Neurosurgery consultations were requested during working hours (p = 0.013)
 Conclusion: Most consultation calls from the ED to neurosurgery are for trauma patients. Brain CT examination is frequently used in neurosurgical patient evaluation. As a result of the consultations, almost half of the patients are hospitalized. Emergency physicians can select patients who need neurosurgery well.

Lesión de Dieulafoy, ¿y eso qué es?

Gastrointestinal bleeding is a common reason for consultation, both in hospital emergency services and in Primary Care. There are multiple etiologies that can motivate it. Dieulafoy's lesion is a rare but potentially serious cause of gastrointestinal bleeding. Its most common location is the stomach. Clinically it is expressed in the form of: melena, hematemesis or hematochezia. Various complementary exams can be used for its diagnosis, such as angiography, angio-CT or endoscopy. Recurrent bleeding treatment consists of embolization through interventional catheterization.

Asistencia ventilatoria de la insuficiencia respiratoria aguda en urgencias. Ventilación mecánica no invasiva y alto flujo nasal

Acute or acute-on-chronic respiratory failure is a common reason for consultation in emergency departments (ED). When conventional treatment is not enough for patients to improve, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula play a fundamental role. Although they were initially exclusively used in critical care units, they have begun to be used in other units in recent years, including hospital EDs. The literature has shown that early use in EDs decreases mortality, improves survival, and decreases the risk of orotracheal intubation and patients’ overall length of stay. Therefore, knowledge of the technique, adequate patient selection, and training for the staff who care for these patients in the hospital emergency department are important.

Arritmias cardíacas. Diagnóstico electrocardiográfico y manejo terapéutico en urgencias

Cardiac arrhythmias are a very common reason for consultation in emergency departments. The most common symptoms that occur are palpitations, chest pain, dyspnea, symptoms of low cardiac output, and syncope, although they can be diagnosed as an incidental asymptomatic finding. The detailed, systematic analysis of a 12-lead electrocardiogram is one of the fundamental tools for its diagnosis. They are classified as tachyarrhythmias and bradyarrhythmias, each of which has specific management according to the symptoms they produce and if they are accompanied by hemodynamic instability or not. Atrial fibrillation is the arrhythmia that causes the most consultations in the emergency department. When faced with wide QRS tachycardia, ventricular tachycardia should be suspected. Immediate care and treatment are needed to reverse it due to its potential mortality, even if it is associated with hemodynamic stability.

Criteria for Treatment of Intranasal Supernumerary Teeth: A Comprehensive Literature Analysis.

Objectives: Among oral surgical conditions, supernumerary teeth of the dental arch is quite common. However, supernumerary teeth in the nasal cavity is a rarity and their diagnosis and treatment have not yet been systematized. We therefore examined the literature on intranasal supernumerary teeth to establish systematic methods for their diagnosis and treatment. Methods: Using the PubMed database, we searched for literature on intranasal supernumerary teeth, published from 1990 to 2019. We combined 131 cases identified in the literature with 1 case that we experienced and summarized the characteristics of 132 cases. We recorded data on sex, age, reason for consultation (chief complaint), reporting department, impact classification, surgical approach, and anesthesia. Results: Males outnumbered females in all decades evaluated. The median age of patients was 10 years. The characteristics of these cases resembled those of maxillary anterior supernumerary teeth. The most common reason for consultation in earlier years was nasal symptoms; however, over time, an increasing number of patients sought consultation due to indications in diagnostic imaging. The most common reporting department in all decades was Otolaryngology. However, reports from Departments of Oral Surgery became increasingly common over time. General anesthesia was applicable for all impaction positions and surgical methods used. Local anesthesia was performed only with the nasal method. Of the 132 patients, 4 experienced no effect from local anesthesia, which was then changed to general anesthesia. Intranasal supernumerary teeth were found to possess the same characteristics as impacted maxillary central supernumerary teeth. Conclusions: The increased use of computed tomography has enabled early detection in asymptomatic cases. Classifying intranasal supernumerary teeth by their vertical and horizontal impaction positions provides an accurate grasp of supernumerary tooth impact classification and the selection of suitable methods of surgery and anesthesia, thus enabling systematic diagnosis and treatment of intranasal supernumerary teeth.

Sex differences in patterns of referral and resource utilization in the cardiology clinic: an outpatient analysis.

Women may have different management patterns than men in specialised care. Our aim was to assess potential sex differences in referral, management and outcomes of patients attending outpatient cardiac consultations. Retrospective observational analysis of patients ≥18 years referred for the first time from primary care to a tertiary hospital cardiology clinic in 2017-2018, comparing reasons for referral, decisions and post-visit outcomes by sex.A total of 5,974 patients, 2,452 (41.0%) men aged 59.2 ± 18.6 years and 3,522 (59.0%) women aged 64.5 ± 17.9 years (P < 0.001) were referred for a first cardiology consultation. The age-related referral rates were higher in women. The most common reasons for consultation were palpitations in women (n = 676; 19.2%) and ECG abnormalities in men (n = 570; 23.2%). Delays to cardiology visits and additional tests were similar. During 24 months of follow-up, women had fewer cardiology hospitalisations (204; 5.8% vs. 229; 9.3%; P = 0.003) and lower mortality (65; 1.8% vs. 66; 2.7%; P = 0.028), but those aged <65 years had more emergency department visits (756; 48.5% vs. 560; 39.9%, P < 0.001) than men. There are substantial sex differences in primary care cardiology referral patterns, including causes, rates, decisions and outcomes, which are only partially explained by age differences. Further research is needed to understand the reasons for these differences.

Nonpharmacological treatment for coping with pain

Pain is one of the most common reasons for consultation and one of the most difficult tasks to handle for doctors. If it is chronic, the frequency of disorders increases associates that we cannot exclude from the treatment, and further complicates your treatment. The Asociation International Association for the Study of Pain (IAPS)1 defines the pain as "a sensory and emotional experience unpleasant associated with actual or potential tissue damage, or described in terms of such damage". So the pain is not only a nociceptive experience, but also involves emotional and subjective components, considering that It can even occur without a somatic cause justify. Its nature is complex, including factors biological and others such as subjective experience, education and emotion. Therefore pain is a personal, multidimensional problem, unique experience and non-transferable of the person who suffers it. Being a pharmacological and non-pharmacological approach is necessary for its management.

Ruling out acute coronary syndrome in primary care with a clinical decision rule and a capillary, high-sensitive troponin I point of care test: study protocol of a diagnostic RCT in the Netherlands (POB HELP)

IntroductionChest pain is a common reason for consultation in primary care. To rule out acute coronary syndrome (ACS), general practitioners (GP) refer 40%–70% of patients with chest pain to the...

Epidemiological and Clinical Profile of Sickle Cell Patients in the Bla Health District

To study the epidemiological-clinical profile of sickle cell patients in the health district of Bla. Method: This was a prospective and descriptive study over 1 year, from February 2021 to January 2022; relating to all patients who were screened with the TDR_Sikle Scan and/or followed up during the study period. Results: We performed the TDR in 982 patients from all the consultations (N= 2976). The mean age was 29.6 ± 3.8 years. SS and SC sickle cell disease represent 8.04% (79 cases). Children 23.52% (28 patients) and women 64.35% (51 patients). SS married couples represented (13.92%). Anemia was the most common reason for consultation (47%), followed by bone and joint pain (29%). 33% of the patients (26 cases) had a complication, of which 15 patients had had a CVO and 6 patients (23%) a worsening of the anemia. We have recorded 1 death. Conclusion: regular medical follow-up of sickle cell patients considerably improves the vital prognosis. The frequency of sickle cell traits remains high including SS and SC forms.