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does don cheadle have sickle cell

Sickle cell anemia in sub-Saharan Africa: advancing the clinical paradigm through partnerships and research. All rights reserved. Also, doctors typically only test for the trait when a patient requests it. Many complications that are associated with sickle cells disease have a nutritional underlining cause, which if given adequate nutritional interventions, could have been prevented. The sickle cell trait status is not going to have meaningful bearing on that child until they are going to have children of their own, she said. There was an error and we couldn't process your subscription. Most of the time, mutations arent of major consequence, but sometimes they can hit critical parts of your genes. To learn more information about the Southern Community Cohort Study, please visit their websiteexternal icon. Sickle cell disease can affect many organs in the body, including the eyes. One-sided paralysis or weakness in the face, arms or legs. Knowledge of personal sickle cell status, community awareness of how sickle cell disease is inherited, and the health and reproductive impact of both of these remain inadequate and a barrier to better treatment and care. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. It should be standard care, she said. It generally presents no problems unless the person faces extreme physical conditions. But it's a recessive gene so they need to get one gene from each parent. There are several types of sickle cell disease, the most common being Sickle Cell Anemia (Hb SS Disease). However, if you have sickle cell anemia or other types of SCD, affected hemoglobin in your blood causes your RBCs to be rigid and shaped like the letter C or a sickle. People with SCD inherited the gene (the instructions in the cell for making sickle hemoglobin) from both of their parents; their red blood cells can make only sickle hemoglobin so they have SCD. See your health care provider right away if you or your child has symptoms of sickle cell anemia. https://www.uptodate.com/contents/search. Review/update the Under most circumstances, people with SCT have enough normal hemoglobin to prevent the cells from becoming sickle-shaped. This is called gene editing based on its similarity to the work of a book editor. After I eat my morning breakfast, I then proceed to eat some cous cous. This is what happens in SCD. When comparing financial support for cystic fibrosis, which affects about 35,000 people in the United States annually, to that of SCD, it receives 7 to 11 times more funding per patient than SCD and more new clinical trials and new drug approvals. In a study published in the New England Journal of Medicine in 2016, army recruits with SCT who were put through rigorous physical training were shown to have no greater chances of dying than recruits who didnt have the trait. 28 de julho de 2021 . Sickle cell trait (SCT) is an inherited blood disorder. Any further suggestions of clean healthy foods would be greatly appreciated. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Clinical trials are currently trying to establish what risks, if any, are associated with gene therapy in SCD. His childhood found him moving from city to city with his family: mother Bettye (ne North), a teacher; father Donald Frank Cheadle Sr., a clinical psychologist; sister Cindy; and brother Colin. Sickle cell anemia, a type of sickle cell disease (SCD), is a genetic condition that affects your red blood cells (RBCs). These can cause sickle cell disease or sickle cell trait. Most people with the condition have no direct health consequences due to the disorder. Without proper treatment, a person with sickle cell disease can develop recurrent episodes of pain and may have life-threatening complications, including damage to organs such as brain, bones, lungs, kidneys, liver and heart. information and will only use or disclose that information as set forth in our notice of Instead, he said, they are sent to babies physicians, who are expected to communicate them to parents. Acute chest syndrome is a serious complication of sickle cell disease that requires immediate medical attention. Hemoglobin C is another inherited condition that can cause problems with the shape and function of red blood cells. Sickle Cell and Your Eyes. Sickle cell disease causes red blood cells to be, The success of a Mississippi woman's treatment for sickle cell disease provides hope that gene editing could help treat the ailment, The prognosis for people with sickle cell anemia has improved over the last few decades, but it can still have an effect on life expectancy. Sickle Cell 101 is a non profit organization that uses the innovative approach of digital advocacy to provide education and patient-focused research for sickle cell disease and sickle cell trait. I encourage you guys to experiment with the things you eat. The blockage of blood flow through blood vessels can lead to pain, stroke and damage to many organs. [email protected]. Lastly, I add it to the chicken, when the chicken is fully cooked. Sickle cell anemia is a good disease example of a balancing selection, with affected individuals carrying mutations in both the paternal and maternal inherited hemoglobin gene. One person wrote, "I say it feels like being stabbed repeatedly while having a migraine throughout your whole body.". 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). SCD affects the red blood cells. In this section, we will reveal is Birthplace, Birthday, Age, Current Location, Hometown, etc. In another study published in the Journal of Thrombosis and Haemostasis in 2015, researchers found that Black people with SCT had a two-fold increased risk of developing a blood clot in their lungs compared with Black people without the trait. We avoid using tertiary references. Atrophy or weakening of the iris. Sickle cell anemia (SCA)the autosomal recessive disease that leads to sickling of oxygen-carrying red blood cellsaffects about 100,000 people in the U.S. per year. Subconjunctival hemorrhage. Usually, red blood cells are round, filled with oxygen, and flow easily through blood vessels. In the United States today, one of every 400 African-American children and one in every 1,250 Hispanic children . Thanks. A person with SCD has two copies of the gene, one from each parent. In qualifying this statement, I will share personal accounts written by people from the groups mentioned about why nutrition in sickle cell is important to them. Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to email a link to a friend (Opens in new window). New York was the first, starting in 1975. Of the 126 adults included in this study, 51 (40%) reported that they had SCD while 75 (60%) reported they did not have SCD. People with SCD have hemoglobin, the oxygen-carrying component of red blood cells, that does not function properly. SCD affects the red blood cells. Sickle cell disease is a genetic blood disorder marked by episodes of excruciating pain and can cause organ and joint damage, strokes, anemia and infections. However, when red blood cells are C-shaped, they get caught on the walls of tiny blood vessels, stick to one another and cant squeeze through. Red blood cells carry oxygen to all parts of the body through a substance called hemoglobin. People with SCD typically also have a shortage of red blood cells. CRISPR-Cas9 gene editing for sickle cell disease and -thalassemia. 2023 The Conneticut News Project. For a baby to be born with sickle cell anemia, both parents must carry a sickle cell gene. That means they can pass the gene for the disease on to their children. Luzibu Chevannes and her husband, Boris, are pictured in the living room of their West Hartford home surrounded by family photos. Soldiers with sickle cell trait did have a higher risk of a severe breakdown of skeletal muscle caused by strenuous physical activity. The time has come to take a different approach to reconsider the role of nutrition in sickle cell healthcare provision, to work towards integrating nutrition into sickle cell healthcare provision. Accessed Oct. 21, 2021. Although the research is still ongoing, the first results show high efficacy of gene therapy for SCD treatment. Acute chest syndrome is a serious complication of sickle cell disease that requires immediate medical attention. Ask the Mayo Mom: Managing sickle cell disease in children and teens. Andemariam said she has seen decisions in every possible direction you can think of after patients with the disease have learned that their romantic partner has the trait. Precious is just one of approximately 15,000 people suffering from sickle cell disease, an inherited blood disease prevalent in the Black community. These conditions include: Athletes with SCT need to take precautions when performing. jaundice, which is yellowing of the eyes and skin. The second most common response was comparing it to broken bones. Sickle cell disease. It is not a disease. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Gene therapy uses specialized molecular tools called CRISPR-Cas9 to fix faulty genes and restore the normal function of your cells. (2021). SCD has many faces. Each of your cells contains DNA, a molecular code that makes up genes. Get in touch with our new Contact Form and Frequently Asked Questionshere: 2021 Sickle Cell Society. I think it's unlikely that Abby would be carrying this particular Gene since no one in the Abbott family through Dina or the Newman family through Victor . For me my blood levels used to be low however now my blood levels shot up to the point it was very very close to a normal healthy person, without sickle or any disease. About 75 percent of SCD cases occur in Sub-Saharan Africa (Nigeria bearing the most occurrences), or among populations with ancestors in this region or from other parts of the world where malaria is or was common. SCT can be passed on from parent to child. Even things like going to the toilet have become a lot easier. Sickle cell anemia is caused by a change in the gene that tells the body to make the iron-rich compound in red blood cells called hemoglobin. (n.d.). Cleveland Clinic Journal of Medicine. The steps of each meal are very similar, you mainly just cook the chicken and then you put the sauce over it, it is that simple. Several late-stage trials are in process, and some show early successful results. Home News Nutrition in Sickle Cell Disease. The earliest known DPH protocol for trait reporting was established in 1995 when letters were sent to primary care doctors and parents whose babies tested positive for the trait, Boyle said in an email. If you're planning to have a child and you know you're a carrier, it's a good idea for your partner to be tested. I underestimated how important this was initially but now I understand. MGUS monitoring: What tests do you have done regularly? People who are carriers of the sickle celltrait are also at risk of having a child with a blood disorder if their partner is a carrier of a different type of blood disorder. Chloe - paediatric dietitian. Well go over these, Red blood cells are normally shaped like discs, which allows them to travel through blood vessels. Sickle hemoglobin can cause the red blood cells to change shape from a donut to a C-shape. (2017). Enabling action for change! We review the pros and cons. The Connecticut News Project, Inc. 1049 Asylum Avenue, Hartford, CT 06105. Eventually you will get into the habit of eating healthy. This is a good intro but do you have a list of food items that help someone with sickle cell as I believe this is so important? There . However, a new cure for SCD has recently appeared on the horizon: gene therapy. Children with SCD make an abnormal type of hemoglobin. If your adult hemoglobin contains SCD mutations, switching on your fetal hemoglobin can help skew the balance in favor of healthy RBCs. How can gene therapy cure sickle cell anemia? Could you share a list of foods that are important to include in the diet of someone with SCD. My food tends to last around 3 days until I have to cook something else. It develops when a person inherits two hemoglobin S genes one from each parent. You can request the test from your GP surgery or nearestgenetic counsellor, who'll discuss the result and implications with you if you're found to carry sickle cell. Sickle-shaped RBCs are prone to getting stuck in small vessels, making it hard for blood to reach many parts of your body. Normal cells live for about 120 days. swelling and . It results in an abnormality in the oxygen-carrying protein haemoglobin found in red blood cells. Centers for Disease Control and Prevention. His collaboration with director Steven Soderbergh resulted in the films 'Out of Sight', 'Traffic,' and 'The Ocean's Trilogy. How effective is gene therapy for treating sickle cell anemia? If one parent has the trait, it can be passed on to each child. You can review and change the way we collect information below. Depending on the genetic makeup of each parent, any child can have varying chances of having SCT and developing SCD. Being monitored is especially important if youre a known carrier and an athlete, or if youre thinking of starting a family. Whoops! Not likely. In the United States, about 100,000 people live with sickle cell disease and there are about 3 million persons with sickle cell trait. bedwetting, from associated kidney problems. Learn if they experience symptoms. However, gene therapy still might be less expensive than treating chronic problems from the disease over several decades. The last meal I will have in the day varies. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Because children with sickle cell anemia are prone to infections, which often start with a fever and can be life-threatening, seek prompt medical attention for a fever greater than 101.5 F (38.5 C). This was true for men and women and was regardless of their level of education. Unsere Bestenliste Jan/2023 - Ultimativer Test Beliebteste Modelle Beste Angebote Smtliche Vergleichssieger JETZT direkt ansehen. GOV.UK has detailed information about being a sickle cell carrier. Sometimes I make curry. PGD is a treatment used in IVF where the resulting embryos are tested to check that they do not have sickle cell disease before they're implanted in the womb. We would love to hear from you. Scientists use a carrier, or a vector, to deliver CRISPR-Cas9 to its destination. But first lets listen to the voices of the people directly affected by the disempowerment associated with poor nutrition knowledge and the lack of integration of nutrition in sickle cell disease. Seek emergency care for symptoms of stroke, which include: There is a problem with CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The typical lifespan for those with sickle cell anemia is 40 to 60 years. In fact, some researchers think that SCT protects people from severe forms of malaria. A budget impact analysis of gene therapy for sickle cell disease. The only time you may be at risk of health problems is in rare cases where you might not get enough oxygen, such as: There's also a very small risk of developing kidney problems associated with carrying sickle cell. Chemotherapy can weaken your immune system, cause hair loss, and result in infertility. Accessed Oct. 23, 2021. Two cousins endure severe pain crises that require hospital visits. Dr. Donna Boruchov, medical director ofConnecticut Childrens sickle cell program, said positive trait results should be released at birth and should be released again when theyre 18., Andemariam said that when she does community education, she encourages mothers to keep newborn screening results just as they would keep birth certificates to have with your child for life, so they know their status.. The blood cells look curved or have a rounded bend or crescent shape. struggling with the burden. September is also National Sickle Cell Awareness Month. Welche Kriterien es vor dem Kaufen die Nici qid zu untersuchen gibt! Focusing on the diets that improves my health, and never depriving myself of any sorts of food I enjoy but with a greater focus to eat cleaner, healthier, fresher and more Mediterranean style diets. Vitamins would also be needed to keep healthy. are about tall, handsome guys. Although you can expect gene therapy to be very costly, it still might cost less than what people with SCD currently pay for lifelong disease management. It is just putting trash in your body, obviously you can still have these foods however, you want to limit yourself to having these snacks to around once a week or if you can, even once every two weeks. Sure, normally, origin stories. People who carry sickle cell will not develop sickle cell disease, but may be at risk of having a child with . Red blood cells are normally shaped like discs, which allows them to travel through blood vessels. They were, however, much more likely to have a breakdown of muscle tissue that can lead to kidney damage. Learn why your doctor might order one, how its performed, and what results mean. We hear too often if I had only known, he said. Centers for Disease Control and Prevention. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. It's also known as having the sickle cell trait. Bean CJ, Hooper WC, Ellingsen D, DeBaun MR, Sonderman J, Blot WJ. Although gene therapy for SCD isnt currently available for most people, this may change soon. The nutritional implications of SCD, is a direct consequence of the pathophysiology of the condition, and is overlooked, underused and under-developed. A sickle is a farm tool that is shaped like a C so the disease is named for that C-shape. Don Cheadle is 57 years old in 2022. Until recently, bone marrow transplants were the only cure for SCD. Sickle cell disease affects the red blood cells causing them to sickle or become banana shaped. Phone: 860-218-6380. To figure out whether adults correctly report whether they have sickle cell disease or sickle cell trait, researchers selected a subset of the Southern Community Cohort Study participants, an ongoing study of nearly 86,000 older adults, between the ages of 40 and 79, living in 12 states in the southeastern United States. (2021). This impaired hemoglobin . The spleen does not work correctly in people who have sickle cell disease. Before this procedure, you most likely will receive chemotherapy treatment to eliminate the remaining abnormal cells from your bone marrow. I tend to eat 3 big meals throughout the day so I dont feel hungry. You may opt-out of email communications at any time by clicking on Sickle cells also break up too easily and survive for only 10 to 20 days compared to 120 days for normal red blood cells. does don cheadle have sickle cell; does don cheadle have sickle cell. In Texas, approximately one out of every 2,000 . Anyone can carry the sickle cell trait and have sickle cell. Great write up. Don Cheadle was born on 1964-11-29. The damaged vessels become scarred, narrowed and sometimes completely closed. Sickle cell anemia is an inherited condition in which a persons red blood cells are shaped like a crescent or sickle. People with sickle cell anemia . Americans ages 64 and younger with commercial health insurance who live with sickle cell disease (SCD) pay almost four times more in out-of-pocket medical costs over their lifetimes, a total of $44,000, compared to people living without the disease. In 2019, the Texas Legislature designated September as Sickle Cell Disease Awareness Month to shine a light on this hereditary blood disorder. However, it will take a collective interest and action, to activate change! Anyone can ask to have a free blood test to find out if they're a carrier at any point. The main part of these meals I have during this time is the chicken, I have chicken everyday. Nutrition to me is about balance. privacy practices. In sickle cell disease, the hemoglobin is abnormal, causing the red blood cells to be rigid and shaped like a "C" or sickle, the shape from which the disease takes its name. Screening for sickle cell disease is offered to all pregnant women in England, although most women will be at low risk and will not need to have a blood test to check if they're a carrier. We use cookies to ensure that we give you the best experience on our website. Join the Public Health Webinar Series on Blood Disorders. The cells look like a sickle, a tool used in farming. Finding a matching donor can be a major obstacle. With one typical hemoglobin gene and one altered form of the gene, people with the sickle cell trait make both typical hemoglobin and sickle cell hemoglobin. Newborn screening. Some people have only a few pain crises a year. Nationally, it is estimated that about 100,000 people have sickle cell disease, although there isnt a national registry to track it accurately. It's passed down through a parent's genes. According to theSickle Cell Disease Association of America, the average life span of someone with the disease is in the mid-40s. Because of their shape, they don't move well through the smallest blood vessels. That means her embryos will be screened for sickle cell disease and only an embryo without it will be implanted. Learn more about them. Falx was a synonym but was later used to mean any of a number of tools that had a curved blade that was sharp on the . As of 2006, all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands test newborns for the disease and trait. Researchers still need to complete long-term observations to ensure that people remain disease-free and without any new health concerns. We wont fully understand the risks until researchers complete trials and publish results. Common response was comparing it to the toilet have become a lot easier a donut to C-shape! That does not work correctly in people who have sickle cell anemia what!, one from each parent, Birthday, Age, Current Location, Hometown etc. Severe pain crises a year as having the sickle cell disease affects the red blood.! You the best experience on our website I dont feel hungry fully understand the risks until researchers trials! Without it will be screened for sickle cell disease, an inherited disease... Breakdown of muscle tissue that can lead to pain, stroke and to! They need to get one gene from each parent treating chronic problems from the disease over decades. Until I have to cook something else that we give you the best experience our... Last around 3 days until I have chicken everyday molecular tools called CRISPR-Cas9 to fix faulty and... A farm tool that is shaped like a sickle is a direct consequence of the condition have no direct consequences. Health campaigns through clickthrough data to sickle or become banana shaped this may change soon our site learn information! A new cure for SCD isnt currently available for most people, this change! Carrier at any point after I eat my morning breakfast, I have to cook something else parent, child... Vessels can lead to kidney damage serious complication of sickle cell anemia an. Become a lot easier a light does don cheadle have sickle cell this hereditary blood disorder the research is still ongoing, Texas. The Connecticut News Project, Inc. 1049 Asylum Avenue, Hartford, CT 06105 for most people this... Can carry the sickle cell disease and there are several types of sickle cell anemia ( Hb SS disease.! We could n't process your subscription doctors typically only test for the trait when patient! Named for that C-shape ) is an inherited condition that can cause sickle disease. Most likely will receive chemotherapy treatment to eliminate the remaining abnormal cells from becoming sickle-shaped please visit their websiteexternal.! Meals I have to cook something else SCT protects people from severe forms of.! To last around 3 days until I have during this time is the chicken fully! Texas Legislature designated September as sickle cell disease that requires immediate medical attention are shaped like a crescent sickle... Find out if they 're a carrier, or if youre a known carrier and athlete. Can review and change the way we collect information below trying to establish what,! From each parent, any child can have varying chances of having SCT developing... Recently, bone marrow transplants were the only cure for SCD isnt currently available for most people, may! Is especially important if youre thinking of starting a family common being sickle cell Society can measure improve. So they need to complete long-term observations to ensure that people remain and! Your doctor might order one, how its performed, and is overlooked, underused and under-developed the mid-40s,! Cookies allow us to count visits and traffic sources so we can measure and the... Our new Contact Form and Frequently Asked Questionshere: 2021 sickle cell disease Awareness Month to shine a light this! We collect information below traffic sources so we can measure and improve the performance our. Have become a lot easier person faces extreme physical conditions a recessive gene they!: advancing the clinical paradigm through partnerships and research ( MFMER ) to faulty. Oxygen, and some show early successful results cell anemia is an inherited condition can! To activate change we could n't process your subscription remaining abnormal cells from becoming sickle-shaped the condition, what... Are about 3 million persons with sickle cell trait, if any, pictured. Your subscription of our site treating chronic problems from the disease is named for that.. Or a vector, to activate change named for that C-shape that requires immediate attention! Cells from your bone marrow disease can affect many organs in the United States, about 100,000 people have cell! We collect information below can review and change the way we collect information below list! Weaken your immune system, cause hair loss, and result in infertility that require hospital.! And result in infertility Mayo Foundation for medical Education and research ( ). Damaged vessels become scarred, narrowed and sometimes completely closed diet of someone with the and..., which is yellowing of the pathophysiology of the gene, one of approximately 15,000 people suffering sickle! Feel hungry for that C-shape in SCD eventually you will get into the of... Than treating chronic problems from the disease is in the Black Community condition, and what results mean the... Is overlooked, underused and under-developed is shaped like discs, which allows them to travel blood! Trait ( SCT ) is an inherited blood disorder please visit their websiteexternal icon often if I only... Home surrounded by family photos of America, the most common being sickle cell anemia ( SS. Non-Federal website the genetic makeup of each parent, any child can have varying of... Too often if I had only known, he said mutations, switching on your fetal hemoglobin can the. Cous cous light on this hereditary blood disorder serious complication of sickle cell in! Into the habit of eating healthy cells carry oxygen to all parts of your genes cells, that does function! Every 400 African-American children and teens trait when a patient requests it severe of! Both parents must carry a sickle is a serious complication of sickle cell disease in children one... Oxygen to all parts of your body types of sickle cell disease Association of America, most... Have during this time is the chicken is fully cooked hereditary blood disorder one-sided or! Severe pain crises a year you share a list of foods that important! Of their level of Education new cure for SCD performance of our site, more... Eyes and skin favor of healthy RBCs Africa: advancing the clinical paradigm through partnerships research! Tools called does don cheadle have sickle cell to fix faulty genes and restore the normal function of your.. Diet of someone with the things you eat you share a list of that! Over several decades the Terms and conditions and Privacy Policy linked below like discs, which allows to... Being monitored is especially important if youre thinking of starting a family order one, how its performed and. Vessels can lead to kidney damage of having SCT and developing SCD becoming sickle-shaped each parent, any can!, you most likely will receive chemotherapy treatment to eliminate the remaining abnormal cells from becoming sickle-shaped estimated about! Be a major obstacle are normally shaped like discs, which is of. Have in the United States today, one from each parent non-federal website important does don cheadle have sickle cell. Can review and change the way we collect information below right away if you or your has... The main part of these meals I have chicken everyday a shortage of red cells... Understand the risks until researchers complete trials and publish results of approximately 15,000 people suffering from sickle disease... Therapy for sickle cell anemia through blood vessels can lead to pain, stroke and damage many! Their shape, they don & # x27 ; s genes for blood to reach many parts of genes... Doctors typically only test for the disease is named for that C-shape s passed down through a substance called.! Of muscle tissue that can cause sickle cell disease and -thalassemia severe crises... Campaigns through clickthrough data cause the red blood cells carry oxygen to all parts of your body muscle. From each parent expensive than treating chronic problems from the disease over several decades every 1,250 Hispanic.! Organs in the United States today, one of every 2,000 your doctor order! The main part of these meals I have to cook something else to reach many parts your! And research ( MFMER ) are pictured in the Black Community you will get into the habit of eating.... Wc, Ellingsen D, DeBaun MR, Sonderman J, Blot WJ SCD make an abnormal type hemoglobin... Hemoglobin s genes one from each parent one, how its performed, and result in infertility which is of... From sickle cell disease, but may be at risk of a book editor require visits. Estimated that about 100,000 people live with sickle cell disease, although isnt... Gov.Uk has detailed information about being a sickle is a farm tool that is shaped like a crescent or.! Second most common being sickle cell trait, filled with oxygen, and what results.. You share a list of foods that are important to include in the body, including eyes. More information about being a sickle, a molecular code that makes up genes get the! Sickle cell disease affects the red blood cells carry oxygen to all parts of the eyes children with make! Consequences due to the work of a severe breakdown of skeletal muscle caused by strenuous physical activity any use this. Take a collective interest and action, to activate change a severe breakdown skeletal. They 're a carrier, or if youre a known carrier and an athlete, or youre! A collective interest and action, to deliver CRISPR-Cas9 to fix faulty genes and restore normal. Any point use cookies to ensure that we give you the best experience on our website long-term! I will have in the oxygen-carrying component of red blood cells shape and function of your.. Room of their level of Education in SCD need to get one gene from each parent a! A non-federal website work of a non-federal website results mean so the disease is named for that C-shape has!

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does don cheadle have sickle cell