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42 INNOSC Theranostics and Pharmacological Sciences, 2023, Vol. 6, No. 1 Hariharan

Figure 3. Forest plot showing the region-wise subgroup analysis of pulmonary hypertension burden
among sickle cell anemia children and adolescents (n = 31).

TRV as a screening procedure, and the children
diagnosed to have PHT using TRV can undergo
cardiac catheterization for further confirmation.
Subgroup analysis was performed to see whether
there is any variation in the burden across the regions.
We found that the SCA children and adolescents
in Europe and EMR had the highest burden of
PHT, while Africa had the least prevalence. The
previous review has also found that the burden of
PHT was higher in the European region and lesser
in the African region [49]. Although the number of
patients with SCA is higher among the people in
African region, the burden of PHTN is lesser when
Figure 4. Funnel plot for checking the possibility compared to European region. This difference in
of publication bias (n = 31).
the burden can be attributed to the better diagnostic
systematic review highlight the need for screening tool availability in high-income region like Europe.
all the children and adolescents with SCA using It may also be due to lack of access to diagnostic

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