Medicine and Health Sciences Commons^™

Quality Of Life In A Cohort Of Kenyan Children With Cerebral Palsy, Pauline Samia, Melissa Tirkha, Amina Kassam, Richard Muindi, Wahu Gitakah, Susan Wamithi, James Orwa, Eugene Were, Michael Shevell

Paediatrics and Child Health, East Africa

Aim: The objective of the study was to evaluate the quality of life in Kenyan children (age 4–18 years) with cerebral palsy (CP).

Methods: A cross-sectional descriptive study was conducted. Children with CP were recruited from the pediatric clinics at the Aga Khan hospital Nairobi (AKUHN). Parent proxy-reports using CPQoL-child and CPQoL-adolescents were obtained. Clinical and demographic data were compiled from medical records and parent interviews. A Likert scale was utilized to determine QoL across several domains.

Results: One hundred and fourteen child–parent dyads with CP were recruited. The median age of study participants was 8 years (IQR 3–13 years), …

Evaluation Of Pharmaceutically Compounded Oral Caffeine On The Impact Of Medication Adherence And Risk Of Readmission Among Preterm Neonates: A Single-Center Quasi-Experimental Study, Gul Ambreen, Manoj Kumar, Amin Ali, Syed Akbar Ali Shah, Syed Muzaffar Saleem, Ayesha Tahir, Muhammad Sohail Salat, Muhammad Shahzad Aslam, Kashif Hussain

Department of Biological & Biomedical Sciences

Background: Caffeine is available in an ampoule, used via parenteral and enteral routes in preterm neonates to treat apnea of prematurity (AOP) in neonates of gestational age ≥ 35-40 weeks. A longer duration of therapy has a higher risk of medication non-adherence due to higher costs and inappropriate dosage forms. Pharmaceutically compounded oral caffeine (PCC) could be an appropriate alternate dosage form. The researchers aimed to determine the impact of PCC on medication-related factors influencing medication adherence (MA) and the frequency of hospital readmission with apnea (HRA) in preterm neonates.
Methods: We conducted a single-center quasi-experimental study for this quality …

Practical Approaches To Improve Vancomycin-Related Patient Outcomes In Pediatrics- An Alternative Strategy When Auc/Mic Is Not Feasible, Kashif Hussain, Muhammad Sohail Salat, Shahzad Rauf, Manoj Rathi, Midhat Khan, Fizzah Naz, Wasif Ahmed Khan, Rahila Ikram, Gul Ambreen

Department of Biological & Biomedical Sciences

Background: Anecdotal experience and studies have shown that most pediatric patients fail to reach target therapeutic vancomycin trough levels (VTLs) and required higher total daily doses (TDD). This retrospective study aims to evaluate the frequency of hospitalized children who achieved target VTLs with a vancomycin (VNCO) dosing regimen of 40-60 mg/kg/d q6h and to assess the VNCO-TDD required to attain the target and their effects on clinical outcomes in pediatric patients.
Methods: After ethical approval, patients of 3 month-12 years were evaluated in this chart review study who received ≥ 3 intravenous-VNCO doses and appropriately drawn blood samples of VTLs …

Optimal Iron Content In Ready-To-Use Therapeutic Foods For The Treatment Of Severe Acute Malnutrition In The Community Settings: A Protocol For The Systematic Review And Meta-Analysis, Aamer Imdad, Melissa François, Fanny F. Chen, Abigail Smith, Olivia Tsistinas, Emily Tanner Smith, Jai K. Das, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Introduction: The current standard of care for children with severe acute malnutrition (SAM) involves using ready-to-use therapeutic food (RUTF) to promote growth; however, the precise formulation to achieve optimal recovery remains unclear. Emerging research suggests that alternative RUTF formulations may be more effective in correcting SAM-related complications such as anaemia and iron deficiency. This systematic review commissioned by the WHO aims to synthesise the most recent research on the iron content in RUTF and related products in the community-based treatment of uncomplicated severe malnutrition in children aged 6 months and older.
Methods and analysis: We will search multiple electronic databases. …

Associations Between Eight Earth Observation-Derived Climate Variables And Enteropathogen Infection: An Independent Participant Data Meta-Analysis Of Surveillance Studies With Broad Spectrum Nucleic Acid Diagnostics, Josh M. Colston, Benjamin F. Zaithcik, Hamada S. Badr, Eleanor Burnett, Syed Asad Ali, Ajit Rayamajhi, Syed M. Satter, Daniel Eibach, Ralf Krumkamp, M Imran Nisar, Anita K. M. Zaidi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Diarrheal disease, still a major cause of childhood illness, is caused by numerous, diverse infectious microorganisms, which are differentially sensitive to environmental conditions. Enteropathogen‐specific impacts of climate remain underexplored. Results from 15 studies that diagnosed enteropathogens in 64,788 stool samples from 20,760 children in 19 countries were combined. Infection status for 10 common enteropathogens—adenovirus, astrovirus, norovirus, rotavirus, sapovirus, Campylobacter, ETEC, Shigella, Cryptosporidium and Giardia—was matched by date with hydrometeorological variables from a global Earth observation dataset—precipitation and runoff volume, humidity, soil moisture, solar radiation, air pressure, temperature, and wind speed. Models were fitted for each pathogen, accounting …

Distance From Healthcare Facilities Is Associated With Increased Morbidity Of Acute Infection In Pediatric Patients In Matiari, Pakistan, Elise Corden, Saman Hasan Siddiqui, Yash Sharma, Sheraz Ahmed, Fayyaz Umrani, Najeeb Rahman, Rafey Ali, Najeeha Talat Iqbal, Syed Asad Ali, Sana Syed

Department of Paediatrics and Child Health

The relationship between environmental factors and child health is not well understood in rural Pakistan. This study characterized the environmental factors related to the morbidity of acute respiratory infections (ARIs), diarrhea, and growth using geographical information systems (GIS) technology. Anthropometric, address and disease prevalence data were collected through the SEEM (Study of Environmental Enteropathy and Malnutrition) study in Matiari, Pakistan. Publicly available map data were used to compile coordinates of healthcare facilities. A Pearson correlation coefficient (r) was used to calculate the correlation between distance from healthcare facilities and participant growth and morbidity. Other continuous variables influencing these …

Pediatric Congenital Heart Diseases: Patterns Of Presentation To The Emergency Department Of A Tertiary Care Hospital, Surraiya Bano, Saleem Akhtar, Uzma R. Khan

Department of Emergency Medicine

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan.
Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as …

Effect Of A Voice Recognition System On Pediatric Outpatient Medication Errors At A Tertiary Healthcare Facility In Kenya, Angela Migowa, William Macharia, Pauline Samia, John Tole, Alfred K. Keter

Paediatrics and Child Health, East Africa

Background: Medication-related errors account for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths. The risk is threefold greater in the pediatric population. In sub-Saharan Africa, research on medication-related errors has been obscured by other health priorities and poor recognition of harm attributable to such errors. Our primary objective was to assess the effect of introduction of a voice recognition system (VRS) on the prevalence of medication errors. The secondary objective was to describe characteristics of observed medication errors and determine acceptability of VRS by clinical service providers.

Methods: This was a before–after intervention study …

Partnerships For Child Health: Capitalising On Links Between The Sustainable Development Goals, Yulia Blomstedt, Zulfiqar Ahmed Bhutta, Johan Dahlstrand, Peter Friberg, Lawrence O. Gostin, Måns Nilsson, Nelson K. Sewankambo, Göran Tomson, Tobias Alfvén

Department of Paediatrics and Child Health

No abstract provided.

Methemoglobin And Nitric Oxide Therapy In Ugandan Children Hospitalized For Febrile Illness: Results From A Prospective Cohort Study And Randomized Double-Blind Placebo-Controlled Trial, Andrea Conroy, Michael Hawkes, Kyla Hayford, Laura Hermann, Chloe Mcdonald, Suparna Sharma, Sophie Namasopo, Robert Opoka, Chandy John, Conrad Liles

Paediatrics and Child Health, East Africa

Background: Exposure of red blood cells to oxidants increases production of methemoglobin (MHb) resulting in impaired oxygen delivery to tissues. There are no reliable estimates of methemoglobinemia in low resource clinical settings. Our objectives were to: i) evaluate risk factors for methemoglobinemia in Ugandan children hospitalized with fever (study 1); and ii) investigate MHb responses in critically ill Ugandan children with severe malaria treated with inhaled nitric oxide (iNO), an oxidant that induces MHb in a dose-dependent manner (study 2).

Methods: Two prospective studies were conducted at Jinja Regional Referral Hospital in Uganda between 2011 and 2013. Study 1, a …

Nitric Oxide Metabolites As Biomarkers For Influenza-Like Acute Respiratory Infections Presenting To The Emergency Room, Asad Mian, Federico R Laham, Andrea T Cruz, Harsha Garg, Charles G Macias, A. Chantal Caviness, Pedro A Piedra

Department of Emergency Medicine

Aims: Nitric oxide (NO) is increased in the respiratory tract in pulmonary infections. The aim was to determine whether nasal wash NO metabolites could serve as biomarkers of viral pathogen and disease severity in children with influenza-like illness (ILI) presenting to the emergency department (ED) during the 2009 influenza A H1N1 pandemic.
Methods: Children ≤18 years old presenting to the ED with ILI were eligible. Nasal wash specimens were tested for NO metabolites, nitrate and nitrite, by HPLC and for respiratory viruses by real-time PCR.
Results: Eighty-nine patients with ILI were prospectively enrolled during Oct-Dec, 2009. In the …

Pediatric Traumatic Putamenal Strokes: Mechanisms And Prognosis, Zain A. Sobani, Arshad Ali

Section of Neurosurgery

Background: Studies have shown that nearly 3% of closed head injuries result in basal ganglia hemorrhages and that this may be a more frequent occurrence in pediatric patients. Various mechanisms based on shearing forces have been implicated in the injury; however, the underlying mechanism leading to the increased incidence in pediatric patients has not been well described. Angiographic data suggest that putamenal perforators in children are more severely stretched at acute angles compared to those in adults, which may be a contributing factor to the increased incidence.
Case description: We discuss a series of five relatively benign cases of traumatic …