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

Efficacy of intravenous iron sucrose infusion in children with iron deficiency anemia: experience at children hospital and ICH Multan

To describe the efficacy of intravenous iron sucrose in children with iron deficiency anemia who did not respond to /tolerate oral iron therapy. Quasi experimental interventional study. A prospective study was performed in 100 children, aged between 08 months and 15 years, 66% male and 33% female, diagnosed as iron deficiency anemia with predefined criteriaexcluding other causes. The children who did not respond to /tolerate oral iron therapy were treated with injectable ironin a day care hematology center. Dose of iron sucrose was calculated by a formula. Total dose was divided in three equal aliquots, each one was diluted in 0.9% normal saline and infused over a period of 120 minutes onthree consecutive days. The efficacy of iron sucrose was analyzed by comparing baseline mean hemoglobin at initiation of therapy and mean hemoglobin level two weeks after iron infusion. Mean age was 4.18 +/- 3.68 years.At start of treatment,baseline meanHb was 6.09 +/- 1.37 g/dl, mean MCV 51.5 +/- 9.03 fl and mean ferritin 7.76 +/- 7.6232 ng/ml. At day 14, mean Hb was 9.21 +/- 1.134 g/dl [P < 0.05], mean MCV 66.5 +/- 7.19 fl and mean ferritin 52.47 +/- 29.6828 ng/ml . Mean hemoglobin rise was 3.12 +/- 1.081 gm/dl [P < 0.05]. During infusion, only one patient had hypotensionwho was treated. Iron sucrose infusion is a safe and effective way of raising hemoglobin in iron deficiency anemia in pediatric age group in special set up with minimal side effects

Frequency of celiac disease in children with iron deficiency anemia at the children hospital and the institute of child health Multan

Objective: To determinethefrequency of celiac disease in patients presenting with iron deficiency anemia"

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Department of Pediatric Gastroenterology, Children's Hospital and the Institute of Child Health; Multan lasted from December 2014 to October 2015

Materials and Methods: Total one hundred patients were enrolled after fulfilling criteria. Non Probability consecutive sampling technique was used for sample collection. Patients were included in study fulfilling age one year to 14 years of both gender and diagnosed as iron deficiency anemia on serum ferittin level less than 15ng/ml. Results: One hundred patients with iron deficiency anemia were enrolled in this study. The mean age of patientswas 4.48 +/- 2.733. Fifty three[53%] male and forty seven [47%] were female. There was a significant difference between groups 1 and 2 in term of gender [p<0.05]. The frequency of celiac disease was 21% in children with iron deficiencyanemia

Conclusion: Screening of celiac disease should be done as a routine investigation in children with iron-deficiency anemia

Treatment outcome of childhood Hodgkin lymphoma after chemotherapy alone

To find the outcome of Hodgkin lymphoma treatment in children without radiotherapy using chemotherapy as a single treatment modality. Descriptive retrospective study. This study was conducted at the Pediatric Oncology Department, Children's Hospital and Institute of Child Health, Multan from January, 2006 to January, 2014. All newly diagnosed children with Hodgkin lymphoma up to the age of 15 years were included in the study. Diagnosis was made on history, clinical examination and lymph node biopsy for histopathology and immunohistochemical staining. X-Ray chest. CT scan of the abdomen, bone scan and bone marrow biopsy were done for staging the disease. Chemotherapy was given to all children according to UKCCSG [United Kingdom Childhood Cancer Study Group] protocol for treatment of Hodgkin lymphoma. Response to treatment was noted after completion of chemotherapy. Among 60 children with Hodgkin lymphoma. 55[92%] were male with M: F = 1 1.5:1.Age range at presentation was 3.5-15 years with mean of 8.5 years. Cervical lymphadenopathy was noted in 52[87%] and mediastinal lymphadenopathy in 8[13%] patients. Stage I, II, III and IV were found in 13[22%], 4[7%], 34[56%] and 9[15%] respectively. Mixed cellularity [MC] was the most common histopathological type, found in 43[72%] patients, followed by nodular sclerosis[NS] in 13[22%] and lymphocyte predominant [LP] in 3[5%].Lymphocyte depleted[LD] type was found in only one patient. On immunohistochemical staining CD30 was positive in all patients. So far, 53 [88%] children have completed their treatment and showed complete response to chemotherapy alone, 4[7%] got relapse and 3[5%] expired during treatment. Most of the children with Hodgkin lymphoma show complete response to the chemotherapy alone and can be treated without radiotherapy. However more patients and long-term follow up is needed for making definite conclusions

Significance of bone marrow biopsy in diagnosis of pediatric diseases; one year experience at a single pediatric hematology/oncology center

Despite the recent advances in the field of hematology in the form of molecular studies and immunophenotyphing, morphological study of bone marrow remains a corner stone in the diagnosis of pediatric hematological diseases. It is also helpful in the diagnosis of many non-hematological diseases. This study is unique in a sense that bone marrow biopsy procedure and morphology reporting were done by a pediatrician trained in clinical hematology. To describe the indications of bone marrow biopsy and frequency of pediatric hematological and non-hematological diseases on morphological basis. This study was conducted at the Pediatric Hematology/Oncology Department, The Children Hospital and the Institute of Child Health Multan from January 2010 to December 2010. This study was conducted on children whether admitted in hematology / oncology ward or referred from various departments of this hospital. A Performa was filled for each patient including detailed history, clinical examination, base line investigation reports and provisional diagnosis. All bone marrow biopsies were performed from posterior iliac spines according to standard protocol for this procedure. Biopsy samples were stained with Leishman stain for morphological study. Bone marrow biopsy report was issued with detailed morphology, morphological diagnosis and suggestion for further investigations e.g. immunophenotyping. Patients age range was 3 months to 13 years with Male: Female = 1:1. Out of 100 bone marrow biopsy reports, disease distribution was acute lymphoblast leukemia [ALL] 30%, acute myeloid leukemia [AML] 7%, lymphoma infiltration 3%, aplastic anemia 18%, idiopathic thrombocytopenic purpra [ITP] 7%, storage disorders 11%, hemolytic anemia 5%, congenital dyserythropoitic anemia [CDA] 2%, red cell aplasia [RCA] 2%, refractory anemia with excessive blasts [RAEB] 2%, nutritional anemia 3%, malaria 3%, reactive changes 5% and normal morphology 2%.In children, acute leukemia is a leading hematological disease on bone marrow morphology followed by aplastic anemia and various non-hematological diseases. Despite availability of advanced diagnostic facilities, bone marrow biopsy is still a useful diagnostic test in many childhood diseases

Health problems in children of imprisoned mothers

To describe the health problems faced by children who accompanied their mothers in the prison. An observational cross-sectional study. 30 children who accompanied their mothers in women jail Multan were examined from 1 October 2009 to 30 December 2009. The department of preventive and social pediatrics visited the woman jail Multan fortnightly for regular medical checkup and support to the children who were residing with their mothers in the jail. All the information regarding their ailments was recorded on a pre-designed questioner. 17 children were male and 13 were female. Mostly children were between 1 to 5 years. Anemia and malnutrition was common. Other illnesses like ARI, scabies Diarrhea and asthma were also noted in these children. One child was suffering from Epilepsy. 26 children were fully vaccinated and 4 were partially vaccinated .childrens environmental condition was inadequate. The children who accompany their mothers in the prison have to face multiple medical and social problems like anemia, malnutrition, infections, asthma and Immunization. These disorders can be prevented by providing adequate living conditions, avoiding overcrowding, providing sufficient and balanced diet, sterilized water, proper Immunization and proper hand washing

Bottle feeding in children under two years of age in Multan; a hospital based study

To explore the factors responsible for bottle-feeding practice among mothers of children less than two years of age in Multan region. An observational cross-sectional study. The patients who were admitted in Pediatric ward and/or attending OPD at Children Hospital and The Institute of Child Health Multan from 1 January 2010 to 26 June, 2010. 450 mothers, feeding their children with bottle, were interviewed about their infant feeding practices. A predesigned questioner was used to get detailed information. Bottle feeding was more prevalent in illiterate 98 [48%] and poor education class mothers, lower social class women 109 [45%], Multigravida 159 [54%] and in the mothers between 26 to 30year of age 78 [61%]. More common causes of bottle feeding were complaint of insufficient milk by mothers 89 [41%] and early baby illnesses 42 [39.2%]. In my study major determinants of bottle feeding are related to poverty and lack of education about breast feeding and proper weaning practices

Patterns of feeding in children under eighteen month of age in Multan; a hospital based study

To see the patterns of feeding in children under eighteen months of age in Multan region. An observational cross-sectional study. Two hundred mothers were interviewed about their infant feeding practices who were admitted in Pediatric ward and/or attending OPD at Children Hospital Multan from 1 January 2009 to 26 March, 2009.Information was collected on a predesigned questionnaire. Exclusive breast feeding declines with age. [Only 24% between the ages of 7 to 12 month]. Continued breastfeeding was practiced more by educated mothers [intermediate and above] 21 out of 23. Only 86 babies were taking complementary feeds, it was seen more between 13 to 18 months of age. Homemade complementary foods were used more as compared to commercial foods Lack of maternal awareness and education about feeding practices was responsible for rapid decline in breast feeding. Therefore it is the dire need to educate the mothers about correct feeding practices for the healthy growth of children in society

Outcome of childhood acute lymphoblastic leukaemia after induction therapy-3 years experience at a single paediatric oncology centre

Acute lymphoblastic leukaemia [ALL] is the most common paediatric malignancy. It represents 25% of all childhood cancers and approximately 75% of all cases of childhood leukaemia. A sharp peak of ALL incidence is observed at 2-5 years of age. Objective was to see the bone marrow remission pattern at the end of induction therapy in paediatric ALL patients in our setup. It was a Descriptive case series and conducted at Paediatric Oncology Department, Children Hospital complex Multan from December, 2005 to December, 2008. Thirty-eight paediatric ALL patients were included in the study. Diagnosis was based on history, examination, blast cells count on peripheral blood film and bone marrow biopsy and immunophenotyping on peripheral blood/bone marrow aspirate. According to UK ALL 2003 protocol all patients were given 4-drug induction therapy, i.e., vincristine, prednisolone/dexamethasone, L-aspiragenase and daunomycin. Bone marrow biopsy was repeated at day 28 of induction therapy and remission pattern was seen. Out of 38 Patients, 26 [68%] were males. Age range was between 2-12 years [Mean 5.4 years]. Bone Marrow Biopsy was done in 38 [100%] and Immunophenotyping in 34 [89%] patients. At day 28 of induction therapy, 28 [74%] patients went into complete remission [<5% blast cells in bone marrow], 2 [5%] into partial remission [5-25% blast cells in bone marrow] and 1 [3%] was not in remission [>25% blast cells in the bone marrow]. Seven [18%] patient died due to febrile neutropenia and sepsis during the course of induction therapy. ALL in children is curable with effective chemotherapy. Remission can be achieved in most of these patients after induction therapy. However outcome can be improved with effective control of infections