Background: Out of pocket (OOP) spending on health contributes significantly to levels of poverty in developing countries such as Pakistan. In poor countries there is reduced or limited access to health services, the issue of affordability and availability which all lead to impaired health status and increased morbidity and mortality rates in developing countries. Catastrophic health expenditure is not always synonymous with high health care costs; even small Out of pocket expenses may cause catastrophic condition for poor people. Methods: This is a cross sectional study that determined the out of pocket cost of computed tomography scan test (CT scan). The study was conducted from April to June 2015. The study population was those patients who came for CT scan at Hira medical center in district Sukkur Sindh Pakistan. The study sample was one hundred and seventy patients. (n=150).  From the perspective of consumer the methodology was adopted, various recurrent costs were determined under different levels of input and cost canters. The data was entered and analyses using SPSS 20 to provide the results as percentages and averages for the different variables in this study. Results: Through this research we found that out of pocket payments are way too high while putting alot of burden on lower socioeconomic groups. Health expenditure Average cost per patient calculated were Rs. 11000 which means people spend more than 40% of  their monthly income on health. There should be a government health facility in the city to compensate the huge cost which people pay for health especially low monthly income people. Conclusion: Government should introduce a health coverage insurance system in Pakistan in order to cover all health care needs of the people irrespective of their socioeconomic status. Keeping in view high out of pocket spending on health, the Government should subsidize the prices of diagnostic test to give relief to its Population. Community participation is also essential for sustainable solutions.

Objective: To determine the diagnostic utility of bone marrow aspirate in finding cause of hepatosplenomegaly. Study Design: Cross Sectional Descriptive study. Setting: Pathology Department of Khyber Teaching Hospital. Period: August 2017 to December 2017. Material & Methods: A total of 116 cases were referred to Pathology department for workup of hepatosplenomegaly during study period. Patients were subjected to bone marrow aspiration and biopsy. The cases were diagnosis was made and those where no specific diagnosis could be made were noted. Mean and standard deviation were used for quantitative variables. Frequency and percentages were used for qualitative variables. Results: Mean age of the study sample was 45±9 years (range 2 -64 years). There were 66 (56.89%) males and 50 (43.10%) females. No specific diagnosis could be made in 36 (31.03%) cases of hepatosplenomegaly. In remaining 80 (68.96%) cases a definitive diagnosis could be made on examining bone marrow aspiration. So the diagnostic utility of bone marrow aspiration examination was 68.96%. Conclusion: Bone marrow aspiration is valuable and diagnostically important tool for workup of cases of hepatosplenomegaly.

Objective: To compare diagnostic value of bone marrow aspiration and bone marrow trephine in reaching to final diagnosis. Study Design: Cross Sectional Descriptive study. Setting: Pathology Department of Khyber Teaching Hospital, Peshawar. Period: December 2015 to September 2016. Material & Methods: About 199 bone marrow procedure were done during study period. Nine cases were excluded because their trephine biopsy specimen was not available. So, the remaining 190 cases, of both the sexes and age above 2 years were included. Bone marrow aspiration and trephine biopsy were obtained from all the patients, and examined. Qualitative data was determined by frequency and percentages. Quantitative data was shown by mean and standard deviation. Results: 190 cases were included in the study. The mean age of the sample was 40 ±11.5 SD years (range: 2 to 81 years). Bone marrow aspirate alone could diagnose 139 (72.8%) cases while trephine biopsy alone was sufficient to diagnose 12 (6.3%) cases. Both the modalities showed similar diagnosis in 39 (20.9%) cases. Conclusion: Leukemias, anemias, and idiopathic thrombocytopenic purpura can be diagnosed by marrow aspiration alone. Aplastic anemia and myelofibrosis need marrow trephine for diagnosis. Both these modalities are important lest any diagnoses should be missed.