Psychiatric disorders and caregiver burden in children with transfusion dependentβ-thalassaemia and their caregivers

BACKGROUND Children with thalassemia need care from the first years of life owing to the physical and psychological effects of their disorder.Thalassemia is a concern not only for the children’s physical health but also the mental health of themselves and their caregivers.AIM To screen the psychosocial problems and assessment of psychiatric morbidities among thalassaemic children and their caretakers,along with an assessment of caregiver burden in them.METHODS In this observational cross-sectional study,children with transfusion-dependent thalassemia,were included and were assessed for psychiatric morbidity and global functioning.Their parents were assessed for psychiatric morbidity and the caregiver burden they faced.All the parents completed two different questionnaires to assess their knowledge about the psycho-social functioning[using Pediatric Symptom Checklist-35(PSC-35)]of their children and the level of the burden faced by them by Caregiver Burden Scale(CBS).RESULTS A total of 46 children(28 boys and 18 girls)with transfusion-dependent thalassemia with a mean age of 8.83±2.70 years and 46 parents(12 fathers and 34 mothers)were included in this study.More than 32 children had some psychosocial problems on screening by PSC-35.On assessment by CBS moderate caregiver burden was perceived in domains of general strain,isolation,disappointment,emotional involvement,and environment.A total of 65.3%of children and 62.7%of parents were diagnosed with psychiatric problems.CONCLUSION Thalassemia affects not only the persons with the disorder but also their caregivers in several aspects,including their psychosocial well-being.This study emphasizes the role of a supportive group in the psychological well-being of caregivers,which could be used to prevent the pathological effects of caregiver burden and enhance their psychological well-being through counselling.

Evaluation of thyroid profile among children aged 1-15 years with nephrotic syndrome:An observation study

BACKGROUND The interaction between the kidney and the thyroid is important for normal function of both organs.In nephrotic syndrome,proteinuria leads to loss of several proteins,which in turn causes hypothyroidism.AIM To assess the thyroid function in children with nephrotic syndrome.METHODS This cross-sectional study was conducted in a tertiary center,Bhopal,from February 2020 to January 2021.Consecutive children aged 1-15 years admitted with nephrotic syndrome(first-time diagnosed and all relapse cases)were included in the study.A thyroid profile was sent along with routine investigations,and thyroid hormone status was assessed in nephrotic syndrome children.RESULTS Of the 70 patients,39(55.7%)showed abnormal thyroid profiles;19(27.1%)had overt hypothyroidism,and 20(28.6%)had subclinical hypothyroidism.Overt hypothyroidism was seen in 16.1%of newly diagnosed cases,40%of second relapses,and 2.7%of frequently relapsed cases(P<0.001).The mean serum free T3 and free T4 levels in frequent relapses were 2.50±0.39 ng/dL and 0.78±0.12 ng/dL,respectively,which were significantly lower than in newly diagnosed cases(2.77±0.37 ng/dL and 0.91±0.19 ng/dL,respectively).The mean thyroidstimulating hormone(TSH)level was significantly higher in frequent relapses (5.86±1.56μIU/mL)and second relapse(5.81±1.78μIU/mL)than in newly diagnosed cases(4.83±0.76μIU/mL)and first relapse cases(4.74±1.17μIU/mL),(P<0.01).CONCLUSION An abnormal thyroid profile was commonly observed in children with nephrotic syndrome,and overt hypothyroidism was more common in frequent relapse cases.Therefore,thyroid screening should be a part of the management of nephrotic syndrome so that hypothyroidism can be detected and managed at an early stage.