Economic burden of thalassemia on parents of thalassemic children: a multi-centre study

Objectives To determine the economic burden of thalassemia on parents of thalassemic children

Study design, settings and duration: Descriptive nonprobability, purposive sampling done in PHRC Research Centres of Multan, Lahore, Islamabad, Karachi, Peshawar and Quetta from July 2013 to June 2014

Patients and Methods: After taking informed written consent, parents/guardians of thalassemia major children were interviewed. All information was recorded on the pre-tested questionnaire. Data was entered and analyzed using SPSS version 11

Results: A total of 600 guardians/ parents of the thalassemic children were included in the study. There were 57% boys and 43% girls with a mean age of 9.40 +/- 5.66 years. Among them, 47.8% were from rural and 52.2 % from urban areas. Almost 71% children were transfusion dependent. The family history of cousin/interfamilial marriage was present in 78.2% while parental consanguinity was present in 72.8%. Only 1.7% parents got premarital screening for thalassemia. In private sector 56.8% had to pay nothing while others had to pay from Rs. 500 to Rs. 2000 per visit. Expenditure per month in private thalassemia centres showed that 57% had to bear no cost at all, 12.2% had to spend up to Rs. 1000, while 24.8% Rs. 1001 to 5000 and 6% had to pay more than Rs. 5000. In the government sector cost per visit in 35.5% was up to Rs. 500 while others had to pay between Rs. 501 to more than Rs. 2000. Monthly cost at government sector almost doubled. Total expenditure [private and government sector] per month was Rs. 9626 for each patient

Conclusion: Total cost [both direct and indirect] for the management of thalassemia was quite high and this cost puts significant economic burden on the affected thalassemic families. This disease puts social, financial and psychological impacts on suffering families, so prevention-based strategies like premarital screening, prenatal diagnosis and genetic counseling should be adopted in Pakistan. A national screening project for thalassemia is the need of the day

Diabetic eye screening in Sir Ganga Ram hospital, Lahore

Diabetic retinopathy is the optical complication that may lead to impaired vision. It is one of the most prevalent but preventable blinding disease. Its early diagnosis is prerequisite for the prevention of the visual loss and blindness associated with diabetic complication. To estimate frequency of eye examination and various types of retinopathy; and to find the association between diabetic retinopathy and its risk factors. The cross sectional study was conducted from Apr-Sep 2012 by PMRC Research Centre, FJMC, Lahore. Using non probability convenient sampling, eighty known type II diabetics were recruited. Venous blood was drawn for plasma glucose level [GOD-PAP] and glycosylated hemoglobin [Ion-Exchange Resin]. Arterial blood pressure was measured using digital apparatus [Oscillometric method]. Visual acuity was tested by Snellen's chart and dilated fundus examination was done to screen diabetic retinopathy. Data was analyzed using Statistical Package for Social Sciences [SPSS-20]. The study included 41% males and 59% females. Mean age was 51 +/- 9 [33-67] years. Diabetics who never screened for retinopathy were 54.3%; and who examined during last year as per IDF guidelines were 25.7%. The frequency of bilateral and unilateral NPDR was 22.5% and 5%, respectively. The occurrence of NPDR was slightly higher in left eye, whereas PDR was more prevalent in right eye. The visual acuity was equal or better than 6/12 in better eye of 80% study participants; and was 6/18-6/36 in better eye of 20% participants. DR was significantly associated with longer duration of diabetes [p-0.010], poorly controlled diabetes [p-0.044] and hypertension [p-0.006]. Odd ratios [95% CI] showed that duration of diabetes [>/= 20 years], glycosylated hemoglobin [>/= 7.5%,]Systolic blood pressure [>/= 140 mm/ Hg] and diastolic blood pressure [>/= 90 mm/Hg] had 3-5 times higher risk of retinopathy. Conclusion: Majority of patients were neither knew nor referred for eye examination. Strict control of diabetes and hypertension may prevent or delay diabetic retinopathy. Policy Message: Annual eye examination must be prescribed by the physician/ diabetologist. An education and awareness program for diabetics and community based survey is highly recommended

Impact of age, gender and diabetes on serum lipid levels

To see the effects of age, gender and diabetes on serum lipid levels. Cross sectional analytical study conducted at PMRC Research Centre, Fatima Jinnah Medical College, Lahore from Jun-Dec 2011. One hundred type 2 diabetes mellitus and equal numbers of gender matched healthy controls were randomly selected for the study. After an overnight fasting, blood specimens were drawn for lipid profile where total cholesterol, high density lipoprotein cholesterol and triglycerides were measured by standard enzymatic endpoint methods and LDL-cholesterol by Friedweld's formula. Statistical analysis was done using SPSS-15. Odd ratios of age for total cholesterol [OR 1.198]; high density lipoprotein cholesterol [OR 1.144]; and low density lipoprotein cholesterol [OR 1.576] revealed that subjects aged 45 years or more had greater risk of having deranged lipid levels. Female gender had higher high density lipoprotein cholesterol [p 0.000] and triglycerides [p 0.001]. Odd ratios of men for total cholesterol [OR 0.775]; high density lipoprotein cholesterol [OR 0.183]; and low density lipoprotein cholesterol [OR 0.683] illustrated that men were significantly less prone to dyslipidemia than women. Odd ratio of diabetes for high density lipoprotein cholesterol [OR 1.802] suggested that diabetics had 1.8 times more risk of having low high density lipoprotein cholesterol. Diabetic females over 45 years of age have significantly high chances of having disturbed or high lipid profile. All persons in general and diabetics in particular over the age of 45 years should be screened for dyslipidemia and informed using behavior change communication to prevent disease complications

Pregnancy related medical problems at a tertiary care hospital

To estimate pregnancy related medical problems in cases visiting care hospital for antenatal care tertiary .Retrospective OPD based study done at medical research laboratory of Ganga Ram Hospital, Lahore from January 2011 to December 2011. A total of 1806 pregnant cases visited the biochemistry laboratory out of which 1000 cases fulfilled the criteria and had complete record available and were selected for analysis. Variable including hemoglobin, blood group and Rh factor, fasting and post prandial plasma glucose, viral markers like HBsAg, Anti-HCV and Anti-HIV l/ll and complete urine examination. Data was analyzed using Statistical Package for Social Sciences [SPSS-15]. The mean age of women was 25.4 +/- 4.29 years and 78.1% were between 21-30 years. The mean fasting and post parandial glucose levels were 84.03 +/- 15 mg/dl and 134.30 +/- 23 mg/dl respectively. Gestational diabetes mellitus was found in 96 cases [6.9%]. HBsAg was present in 1.2%, HCV in 8.5% and both B and C were present in 1 case. None had HIV l/ll infection. Blood group 'B' was commonest [34.2%], followed by group 'O' [30.6%], group 'A' [24.5%] and 'AB' [10.7%]. Rhesus factor [Rh] showed 94% Rh-positive cases and 6.0% Rh negative. Overall anemia was present in 61.1% cases with mild anemia in 87.5%, moderate in 12.2% and severe in 0.1%. Urinary tract infection was seen in 10.1 % cases. Anemia was common in pregnancy. Urinary tract infection [10%], hepatitis C virus exposure [8.5%] and gestational diabetes mellitus [7%] were common. Although the screening of HCV is not recommended internationally but the rate of HCV infection is on increase in Pakistan so there is a need of proper screening of HCV along with routine antenatal screening. It will help to identify asymptomatic women, who may benefit from antiviral therapy at a time when they are more receptive to medical intervention

Socio demographic characteristics of male heroin addicts

Current descriptive study on heroin addiction in Karachi, Pakistan was conducted to explore the socio demographic characteristics of male addicts who belong to lower socioeconomic status. Descriptive study. Karachi, Pakistan. The sample of 306 heroin addicts was taken from Karachi, Pakistan. Detailed interviews were conducted according to the form developed by researchers. Means, standard deviations and percentages were calculated by using SPSS [V.12]. The results indicate that mean age of the sample was 32.87 [range- 10-70 years]. The majority of [62%] individuals had gotten education below 5[th] grade, 42 [13.72%] had gotten education till 5[th] grade. 58.2% of addicts were single. The mean of total duration of drug use in our sample was 11.99 years [range= 1-41 years]. 34.3% of addicts were involved in different crimes and were arrested. In overall sample 51% were involved in pre marital and extra marital sexual relations

Glycemic control of type 2 diabetes mellitus

To determine the frequency of use of HbA1c level as an indicator for type 2 diabetes control and to identify the Glycaemia control among type 2 diabetic patients. A retrospective study. Dair Health Center. Medical records of all diabetic patients were reviewed for having a test result of HBA1c and for the average level of this test from first of January till the end of December 2004. The time of record review was from first of April 2005 till the end of May 2005. Among 383 type 2 diabetic patients treated at Dair Health Center during 2004, only 178 cases [46.5%] had HBA1c test. Out of these, twenty cases [11.2%] had an HBA1c level of 7% and below. There was no statistically significant difference between the mean of HBA1c for males and females. There was no statistically significant difference between the mean of HBA1c and the type of treatment. HBA1c was underused as an indicator for diabetic control in Dair health center. Furthermore, more stress on strict Glycemic control needs to be emphasized

Team size, communication and need for achievement as predictors of team effectiveness

The purpose of the present study was to investigate the relationship of team effectiveness with team size, communication and need for achievement. Sample consisted of 40 male employees of different advertising agencies, who were working in a team. Team Effectiveness Inventory was administered to measure team effectiveness, communication within the team and need for achievement of team members. Personal data form was also administered to gather the demographic information and to find out the number of people working in the group. Pearson Product Moment Correlation was then applied. Negative correlation between team size and team effectiveness, and a positive correlation of team effectiveness with need for achievement and level of communication was found. Regression analysis also indicates team size, communication and need for achievement to be signficiant predictors of team effectiveness