Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study.

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.

Diphtheria in Pakistan post-COVID-19, a potential public health threat: an update.

Diphtheria, a vaccine-preventable disease, remains a concern in Pakistan as cases have risen post-COVID-19 pandemic causing more than 45 deaths in Pakistan in the year 2022. The respiratory variant of the disease is more common and can lead to serious complications, such as myocarditis and respiratory insufficiency. Diphtheria has caused havoc in the past killing millions of people worldwide before the development of its vaccine. Although the diphtheria toxoid vaccine is effective against toxigenic strains, there have been cases of treatment-resistant strains, particularly the non-toxigenic strains of C. diphtheriae. Pakistan's economic and health systems have suffered setbacks, which have been exacerbated by the COVID-19 pandemic. The pandemic has disrupted routine vaccination programs, and recent floods have contributed to an increase in diphtheria cases and rendered millions homeless. Poor immunization services, inadequate training of vaccination teams, and wealth inequality have all contributed to unequal vaccination coverage in Pakistan. The rising cases of diphtheria call for prompt action, including booster shots, updating vaccination records and administering immediate doses of the toxoid to close contacts.