Assessing burden and its determinants in caregivers of chronic kidney disease patients undergoing haemodialysis

Background: Caregivers face a lot of adversities while supporting their near ones undergoing haemodialysis, and their burden is often ignored by health professionals. The paucity of research in the Indian context has kept their needs out of sight. Aim: To explore the level of burden in the caregivers of patients with chronic kidney disease (CKD) undergoing haemodialysis and to assess whether patient related variable affects the burden. Methods: Fifty-one patients and their caregivers from two dialysis units in Sikkim, India, were assessed cross-sectionally. The Zarit Caregiver Burden Scale (ZCBS) was administered to measure the caregiver burden. The Patient Health Questionnaire-9 (PHQ-9) and the Charlson’s Comorbidity Index (CCI) assessed the patient’s depression and medical comorbidities, respectively. Descriptive analysis was done for the sociodemographic and clinical variables. Chi-square test was used to find the association between the categorical data. Kruskal-Wallis tested the association between categorical and quantitative variables. Results: Mean age of patient was 46.13 (±13.15) years and that of the caregiver was 44.78 (±12.14) years. 68.6% of caregivers had mild to severe levels of caregiver burden. Caregivers who were unemployed and educated till secondary school were more likely to report caregiver burden. Female gender, older caregivers, and caregivers attending patients with a longer history of haemodialysis reported a more severe burden. Conclusion: The level of burden in caregivers of CKD patients is significant and is affected by various factors, which, in turn, also affects patient’s wellbeing. Further research in this area is needed in our country for better management of patients and policymaking.

Effect of inhaled terbutaline on platelet activity in bronchial asthma.

Thirty five young subjects with long standing bronchial asthma were studied for the effects of terbutaline misthaler (500 micrograms) during acute asthma. Bronchodilators were omitted for a day before the test. Ten matched controls were also studied. In all subjects, basal IgE level (ELISA), pulmonary parameters (FVC, FEV, PEFR, FEF 25-75 and FEF 75-85) and platelet activity, (platelet clumping/150 WBC on smear, platelet adhesiveness, blood recalcification time and kaolin clotting time for platelet factor3) were compared. During acute asthma, the subjects displayed IgE levels > or = 500 IU/ml (n = 33), activation of clotting (n = 30) and eosinophilia > or = 450/cmm (n = 28). These changes were not seen in normal controls. Terbutaline resulted in a reversal of airway obstruction, mainly of small airways, while the platelet hyperactivity and blood hypercoagulability were rectified (P < 0.001). It is concluded that platelet activity increases in acute asthma and is corrected by inhaled terbutaline concomittant with the relief of bronchospasm.

Immunoglobulins and allergy mediators in bronchial asthma.

Seventy four young asthmatics were evaluated to establish the role of immunoglobulins and allergy mediators in clinical asthma. They were categorized into Group I (n = 38) or Group II (n = 36) when having mild or severe bronchospasm respectively. In some patients, reversibility of bronchospasm (n = 35), exercise challenge (n = 24) and intradermal allergy testing (n = 24) were also studied. Seventy subjects had raised IgE levels (greater than 100 KU/L) but these did not correlate with the severity of clinical or exercise induced asthma or with reversibility of bronchospasm. An IgE level greater than 1000 KU/L was associated with more number of positive skin tests. Group II subjects had a shorter blood recalcification time (p less than 0.01) and higher levels of IgG, histamine and serotonin (p less than 0.001). It appears that severe asthma is associated with activation of blood coagulation, and release of allergy mediators contributes to the evolution of bronchospasm. Total IgE predicts the utility of skin testing in asthma.