Willingness to Pay for Community-Based Healthcare Insurance Schemes in Developing Countries: A Case of Lahore, Pakistan

BACKGROUND: Healthcare costs and poverty are significant barriers to achieving universal access to healthcare. Thus, Community-Based Health Insurance Schemes (CBHIS) are regarded as an influential instrument for providing access to healthcare. For this purpose, this study was carried out in order to assess the community’s Willingness to Pay (WTP) for CBHIS and its determinants among the residents of Lahore City.METHODS: A cross-sectional study was adopted during the period of May 2018 to August 2018 to conduct a standardized questionnaire survey among targeted population of Lahore. A total of 250 households from lower, middle and upper-middle-class areas were approached randomly from which 200 participated in the survey, rendering a response rate of 90.9%. Sample size was determined by using single population proportion formula assuming 5% margin of error and 95% Confidence Interval (CI). Moreover, multiple regression analysis, Pearson’s correlation and t-test were employed to determine relationships between different variables affecting WTP.RESULTS: Sixty-four percent of the respondents were willing to pay for CBHIS. Among the remaining thirty-six% of unwilling the community, income level (p< 0.05, CI=0.34 to 1.11) and education level (p< 0.05, CI=0.52-1.37) were significant predictors of WTP. Moreover, strong positive relation (p<0.05) between people’s awareness and WTP for CBHIS was witnessed. The findings further suggested that the larger population of the willing community was not willing to pay more than 5000 Rs annually.CONCLUSION: Henceawareness level of the community regarding the benefits of CBHIS is a major hindrance. The key policy priority is to increase the community’s awareness regarding the benefits of CBHIS and to increase willingness to pay rate among public.&nbsp

Levels of Natural Anticoagulants Protein C, Protein S and Antithrombin III in Patients with Solid Malignancies

Background: To estimate plasma levels of natural anticoagulants, i.e., Protein C, Protein S and Antithrombin III in patients with solid malignanciesMethods: A cross-sectional study was conducted wherein plasma levels of Protein C,S and Antithrombin III (AT III) in patients with solid malignancies were determined. The studied parameters included age, gender ,type of the tumor, stage of the cancer and plasma levels of protein C, S and antithrombin.A total of 91 samples from patients with solid tumors were selected using consecutive non-probability sampling method..Protein C,S and antithrombin levels in the plasma were determined using fully automated coagulation analyzer CA-500 (Sysmex Japan).Results: Total 91 patients fulfilled the inclusion criteria. The age range was 30 to 70 years. Mean age was 47.87±13.56 years . Out of the 91 patients, 43 (47.23%) were females and 48 (52.73%) were males, with a male to female ratio of1.1:1. Frequent malignancies noted in males were head and neck (10.98%), GIT (9 %), lymphoma (8.79%). In females breast cancer was the most common cancer accounting for 14.28 % followed by GIT (9.89 %), Head and neck (7.69 %) . Majority of the patients (67%) were in stage IV .Out of 91 patients, 58,2% and 4.4% were found Protein S and C deficient, respectively. AT III levels were above normal in majority (53.8%).With regards to stage of tumor decreased levels of these natural anticoagulants in stage I, II, III and IV were 2.19%, 3.29%, 6.59% and 48.35% respectively . Higher incidence of thrombophilia was noted in patients with Ca breast (20%) followed by tumors of G.I.T and tumours of head and neck due to low levels of Protein S .Conclusion: Increased frequency of thrombophilia is noted in patients with solid tumors (60%).Protein S deficiency is a major factor (92.7% of the total thrombophilic patients) leading to thrombophilic state in cancer population

Levels of Natural Anticoagulants Protein C, Protein S and Antithrombin III in Patients with Solid Malignancies

Background: To estimate plasma levels of natural anticoagulants, i.e., Protein C, Protein S and Antithrombin III in patients with solid malignanciesMethods: A cross-sectional study was conducted wherein plasma levels of Protein C,S and Antithrombin III (AT III) in patients with solid malignancies were determined. The studied parameters included age, gender ,type of the tumor, stage of the cancer and plasma levels of protein C, S and antithrombin.A total of 91 samples from patients with solid tumors were selected using consecutive non-probability sampling method..Protein C,S and antithrombin levels in the plasma were determined using fully automated coagulation analyzer CA-500 (Sysmex Japan).Results: Total 91 patients fulfilled the inclusion criteria. The age range was 30 to 70 years. Mean age was 47.87±13.56 years . Out of the 91 patients, 43 (47.23%) were females and 48 (52.73%) were males, with a male to female ratio of1.1:1. Frequent malignancies noted in males were head and neck (10.98%), GIT (9 %), lymphoma (8.79%). In females breast cancer was the most common cancer accounting for 14.28 % followed by GIT (9.89 %), Head and neck (7.69 %) . Majority of the patients (67%) were in stage IV .Out of 91 patients, 58,2% and 4.4% were found Protein S and C deficient, respectively. AT III levels were above normal in majority (53.8%).With regards to stage of tumor decreased levels of these natural anticoagulants in stage I, II, III and IV were 2.19%, 3.29%, 6.59% and 48.35% respectively . Higher incidence of thrombophilia was noted in patients with Ca breast (20%) followed by tumors of G.I.T and tumours of head and neck due to low levels of Protein S .Conclusion: Increased frequency of thrombophilia is noted in patients with solid tumors (60%).Protein S deficiency is a major factor (92.7% of the total thrombophilic patients) leading to thrombophilic state in cancer population

Atypical Sjögrenʼs Syndrome Initially Presenting as Lymphocytic Interstitial Pneumonitis followed by Immune Thrombocytopenia

Background. Sjögrenʼs syndrome is an autoimmune disease characterized primarily by decreased exocrine gland function leading to eye and mouth dryness. Extraglandular manifestations occur less frequently. Case Report. A 74-year-old man with hypertension was admitted with productive cough and fever. On physical examination, he had bilateral lower lung decreased breath sounds. A chest radiograph showed bibasilar patchy infiltrate. Laboratory studies revealed hemoglobin of 11.9 g/dL, white blood cell count of 16,000/uL, and platelet count of 250,000/uL. Empiric antibiotic therapy was begun for suspected community acquired pneumonia, and then he was discharged home. However, his cough recurred. Chest computed tomography demonstrated adenopathy throughout the mediastinum and multiple ill-defined patchy groundglass opacities with a lower lobe prominence. He underwent a transbronchial biopsy to rule out malignancy; however, it showed lymphocytic interstitial pneumonitis. Antinuclear antibody was 1 : 80 homogeneous, and anti-SSA antibody was 6.3 AI (normal <1.0 AI). The patient was treated with prednisone 20 mg/day with marked improvement in his symptoms. Repeat chest computed tomography showed decreased groundglass opacities and decreased mediastinal lymph nodes. After more than a year, he was readmitted due to petechiae on his buccal mucosa and a platelet count of 2000/μL. The patient was started on prednisone 80 mg/d and intravenous immunoglobulin 80 g/d for 2 consecutive days. The platelet count eventually increased to 244,000/μL. Conclusion. We report a rare presentation of Sjogrenʼs syndrome manifesting as acute lymphocytic interstitial pneumonitis and followed by immune thrombocytopenia. Both extraglandular manifestations responded well to corticosteroid therapy

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally