Psychological Aspects in Children and Adolescents With Major Thalassemia: A Case-Control Study

BACKGROUND

Thalassemia is an inherited blood disease. It is a serious public health problem throughout the Mediterranean region, the Middle East and the Indian subcontinent, as well as in Southeast Asia.

OBJECTIVES

Thalassemia is an inherited blood disease. It is a serious public health problem. In this study we assessed psychological aspects in Iranian children and adolescents with thalassemia major.

PATIENTS AND METHODS

In this case-control study sixty healthy subjects aged 7-18 years and Sixty Patients with confirmed diagnosis of major thalassemia were enrolled. After obtaining informed consent from parents of all participating thalassemia patients and healthycontrols, we assessed psychological aspects and quality of life by Pediatric Quality of LifeTM (PedsQL™), Strengths and Difficulties Questionnaires (SDQ), State and Trait Anxiety, Children's Depression Inventory (CDI).

RESULTS

The results of this study indicate that there are significant changes in depression, anxiety, QOL and behavioral screening between children with thalassemia major compared with healthy subjects by means of both parents and children reports. According to the results, children with thalassemia major have more psychological problems than healthy ones. Patients with thalassemia have a lower QOL than their peers (P = 0.001), the rate of depression is higher in this group (P = 0.015), Also behavioral problems in these children are more than healthy subjects (P = 0.009).

CONCLUSIONS

We recommend appropriate treatment and counseling procedures in addition to specific treatment of thalassemia. According to the results we suggest to establish pediatric psychiatric clinics beside thalassemic clinics to cure psychological aspects of the disease.

Lactulose for reduction of nitrogen products in patients with chronic kidney disease

INTRODUCTION

Patients with chronic kidney disease (CKD) face with uremic toxins. Lactulose could reduce serum urea and creatinine levels and have some effects on lipid profile and bone minerals. The aim of this study was to evaluate effect of lactulose on serum levels of biochemical products in patients with CKD.

MATERIALS AND METHODS

In this prospective study, 40 patients with stages 3 and 4 of CKD (52.5% men; mean age, 57.5 ± 12.5 years) were evaluated. All patients received lactulose, 30 mL, 3 times per day for 2 months. Blood samples from all participants were collected before and at the end of intervention to examine changes in biochemical parameters, including sodium, potassium, hemoglobin, urea, creatinine, uric acid, leukocyte and platelets count, β2-microglobin, and intact parathyroid hormone.

RESULTS

Lactulose significantly decreased urea levels from 70.35 ± 28.00 mg/dL to 64.50 ± 23.51 mg/dL (P = .04), creatinine levels from 4.04 ± 1.78 mg/dL to 3.45 ± 1.39 mg/dL (P < .001), uric acid levels from 7.31 ± 1.49 mg/dL to 6.71 ± 1.42 mg/dL (P < .001), and β2-microglobin levels from 3.25 ± 0.44 mg/L to 3.08 ± 0.33 mg/L (P = .001). The decrease in serum electrolytes, lipid profile, and intact parathyroid hormone levels were not significant.

CONCLUSIONS

Lactulose administration in CKD patients could decrease levels of various deleterious elements, especially nitrogen products, and its daily use can be recommended in these patients.