Medicine and Health Sciences Commons^™

Task Sharing And Shifting To Provide Pathology Diagnostic Services: The Kenya Fine-Needle Aspiration Biopsy Cytology And Bone Marrow Aspiration And Trephine Biopsy Training Program, Shahin Sayed, Andrew Field, Jamilla Rajab, Anderson Mutuiri, Jessie Githanga, Mary Mungania, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Brian Ayara, Erick Chesori, Julia Muthua, Leah Obosy, Thaddeus Massawa, Okoth Obiero, Elizabeth Kagotho, Peter K. Shikuku, Andrew K. Gachii, Eunidah Migide, Donstefano Muninzwa, Sanford M. Dawsey, Lucy Muchiri

Pathology, East Africa

Purpose: Fine-needle aspiration biopsy (FNAB) cytology is a simple, inexpensive, and accurate diagnostic test for benign, infectious, and malignant lesions of the breast, thyroid, lymph nodes, and other organs. Similarly, bone marrow aspiration and trephine (BMAT) biopsy procedures are relatively simple and inexpensive techniques that are important for diagnosing and monitoring many hematologic diseases including leukemias and lymphomas. However, the scarcity of pathologists in Kenya limits patient access to these simple diagnostic tests. We describe a task sharing and shifting program that sought to improve the provision of FNABs and BMAT biopsies in tertiary public hospitals in Kenya.

Methods: Between …

Advancing Universal Health Coverage In South Asian Cities: A Framework, Alayne M. Adams, Devaki Nambiar, Sameen Siddiqi, Bushra Binte Alam, Srinath Reddy

Department of Paediatrics and Child Health

No abstract provided.

Measuring And Understanding Social-Emotional Behaviors In Preschoolers From Rural Pakistan, Jenna E. Finch, Aisha Khizar Yousafzai, Muneera Rasheed, Jelena Obradović

Department of Paediatrics and Child Health

The Strengths and Difficulties Questionnaire (SDQ) is widely-used to measure symptoms of common childhood behavioral problems that may lead to mental health difficulties. In a sample of 1,302 highly-disadvantaged mothers and their preschoolers, we evaluated the factor structure and reliability of the parent-report version of the SDQ in rural Pakistan. Confirmatory factor analyses suggested that the original structure of the SDQ was not appropriate for our data. We created conceptually- and empirically-coherent measures of children’s externalizing behavior problems and prosocial skills. Child and family correlates of social-emotional behaviors were similar to those found in other countries, supporting the validity of …

Tuberculous Granuloma On Bone Marrow Trephine, Farheen Karim, Hira Qadir

Department of Pathology and Laboratory Medicine

Bone marrow examination is a useful tool for diagnosis of many diseases. The utility of bone marrow examination in workup of pyrexia of unknown origin cannot be undermined. Bone trephine of patients presenting with pyrexia of unknown origin must be carefully looked upon for granulomas for evaluation of tuberculosis. In this case, bone marrow trephine aided in timely diagnosis of tuberculosis in a patient.

Characteristics Of Traumatic Out-Of-Hospital Cardiac Arrest Patients Presenting To Major Centers In Karachi, Pakistan-A Longitudinal Cohort Study, Minaz Mawani, Muhammad Masood Kadir, Iqbal Azam Syed, Junaid Abdul Razzak

Section of Cardiology

Background: Trauma is the leading cause of death for adults under 44 years of age. Survival after traumatic out-of-hospital cardiac arrest (OHCA) has been reported to be poor, and its epidemiology is not well defined. A few studies have reported better survival in response to pre-hospital life-saving interventions. Currently, no published data on traumatic cardiac arrests in the field exist from low- and lower middle-income countries. We aimed to explore the epidemiology and outcomes of traumatic OHCA patients from Karachi, Pakistan. We conducted a longitudinal cohort study at emergency departments (ED) of five major public and private hospitals of the …

The Logistics Of Voucher Management: The Underreported Component In Family Planning Voucher Discussions, Moazzam Ali, Madeline Farron, Syed Khurram Azmat, Waqas Hameed

Community Health Sciences

Background: The purpose of health care vouchers or coupons is to receive a health service in exchange which is fully or partially subsidized, such as any treatment offered for communicable disease; for immunization; antenatal care-/postnatal care-related maternal health services; a family planning (FP) service; or to get a health commodity like a medicine. Vouchers are targeted for a group of people who can benefit the most such as on the basis of poverty ranking, marginalized or living in rural areas. According to the World Health Organization, voucher schemes in the area of sexual and reproductive health are considered of high …

“His Mind Will Work Better With Both Of Us”: A Qualitative Study On Fathers’ Roles And Coparenting Of Young Children In Rural Pakistan, Joshua Jeong, Saima Siyal, Günther Fink, Dana Charles Mccoy, Aisha Khizar Yousafzai

Department of Paediatrics and Child Health

Background: Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan.
Methods: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). …

His Mind Will Work Better With Both Of Us”: A Qualitative Study On Fathers’ Roles And Coparenting Of Young Children In Rural Pakistan, Joshua Jeong, Saima Siyal, Günther Fink, Dana Charles Mccoy, Aisha K. Yousafzai

Department of Paediatrics and Child Health

Background:
Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan.
Methods:
Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). …

Multicentre Pilot Study Evaluation Of Lung Ultrasound For The Management Of Paediatric Pneumonia In Low-Resource Settings: A Study Protocol, Jennifer L. Lenahan, Giovanni Volpicelli, Alessandro Lamorte, Fyezah Jehan, Quique Bassat, Amy Sarah Ginsburg

Department of Paediatrics and Child Health

Introduction:
Pneumonia is the leading infectious cause of death among children under 5 years of age worldwide. However, pneumonia is challenging to diagnose. Lung ultrasound (LUS) is a promising diagnostic technology. Further evidence is needed to better understand the role of LUS as a tool for the diagnosis of childhood pneumonia in low-resource settings.
Methods and analysis:
This study aims to pilot LUS in Mozambique and Pakistan and to generate evidence regarding the use of LUS as a diagnostic tool for childhood pneumonia. Children with cough <14 days with chest indrawing (n=230) and without chest indrawing (n=40) are enrolled. World Health Organization Integrated Management of Childhood Illness assessment is performed at enrolment, along with a chest radiograph and LUS examination. Respiratory and blood specimens are collected for viral and bacterial testing and biomarker assessment. Enrolled children are followed for 14 days (in person) and 30 days (phone call) post-enrolment with LUS examinations performed on Days 2, 6 and 14. Qualitative and quantitative data are also collected to assess feasibility, usability and acceptability of LUS among healthcare providers and caregivers. The primary outcome is LUS findings at enrolment with secondary outcomes including patient outcomes, repeat LUS findings, viral and bacterial test results, and patient status after 14 and 30 days of follow-up.
Ethics and dissemination:
This trial was approved by the Western Institutional Review Board as …

Nursing & Midwifery: The Key To The Rapid And Cost Effective Expansion Of High Quality Universal Healthcare, Nigel Crisp, Sharon Brownie, Charlotte Refsum

School of Nursing & Midwifery, East Africa

Nurses and midwives play a central role in all health systems. They support people in every aspect of their health and wellbeing – from health promotion to chronic disease management and specialist services. Together they make up half of the professional health workforce globally and account for about 90 percent of the contacts between patients and health professionals. This report argues that countries that invest in and develop their nursing and midwifery workforce can achieve a rapid, cost-effective expansion of high-quality UHC. This will also help to realize the World Health Assembly (WHA) target of 1 billion more people benefiting …

Impact Of Maternally Derived Pertussis Antibody Titers On Infant Whole-Cell Pertussis Vaccine Response In A Low Income Setting, Romesa Ibrahim, Syed Asad Ali, Abdul Momin Kazi, Arjumand Rizvi, L. Beryl Guterman, Robert A. Bednarczyk, Ellie Kim, Sohee Park, Simon Paulos, Amilia Jeyachandran

Department of Paediatrics and Child Health

Background: Maternal vaccines against pertussis are not yet recommended in the developing world. Besides unclear burden estimates, another concern is that transplacental transfer of maternal pertussis antibodies could result in attenuation of the immune response to whole cell pertussis (DTwP) primary vaccination series in infants. This study was taken up to determine whether higher levels of maternal pertussis antibodies attenuate immune response of infants to DTwP vaccination series given at 6-10-14 weeks of age.
Methodology: A total of 261 pregnant women and their infants from four low-income settlements in Karachi, Pakistan were enrolled in this study. The study endpoints were …

Phase I Of The Surveillance For Enteric Fever In Asia Project (Seap): An Overview And Lessons Learned, Caitlin Barkume, Kashmira Date, Samir K. Saha, Farah Qamar, Dipika Sur, Jason R. Andrews, Stephen P. Luby, M Imran Khan, Alex Freeman, Mohammad Tahir Yousafzai, Denise Garret

Department of Paediatrics and Child Health

Objective: The objective of Phase I of the Surveillance for Enteric Fever in Asia Project (SEAP), a multiphase surveillance study characterizing the burden of disease in South Asia, was to inform data collection for prospective surveillance and to capture clinical aspects of disease.
Methods: Through a retrospective record review conducted at hospitals in Bangladesh, India, Nepal, and Pakistan, we examined laboratory and clinical records to assess the culture positivity rate for Salmonella Typhi and Salmonella Paratyphi, age and sex distribution, and antimicrobial susceptability in each country.
Results: Of all blood cultures performed in Bangladesh, India, Nepal, and Pakistan, 1.5%, 0.43%, …

A Retrospective Study Of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014, Farah Naz Qamar, Mohammad Tahir Yousafzai, Shazia Sultana, Attaullah Baig, Sadia Shakoor, Farzeen Hirani, Abdul Wassay, Sehrish Khushboo, Junaid Mehmood, Alexander Freeman

Department of Paediatrics and Child Health

Introduction: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multisite surveillance study designed to capture morbidity and mortality burden of enteric fever (typhoid and paratyphoid) in Bangladesh, Nepal, and Pakistan. We aim to describe enteric fever disease burden, severity of illness, and antimicrobial resistance trends in Pakistan.
Methods: In this retrospective, cross-sectional study, laboratory records of hospitalized patients who received a blood culture in any of 3 Aga Khan University hospitals in Karachi and Hyderabad, Pakistan, from 2012 to 2014 were reviewed. A case was defined as having a positive blood culture for Salmonella Typhi (S. Typhi) …

Integrating Facility-Based Surveillance With Healthcare Utilization Surveys To Estimate Enteric Fever Incidence: Methods And Challenges, Jason R. Andrews, Caitlin Barkume, Alexander T. Yu, Samir K. Saha, Farah Qamar, Denise Garrett, Stephen P. Luby

Department of Paediatrics and Child Health

Cohort studies and facility-based sentinel surveillance are common approaches to characterizing infectious disease burden, but present trade-offs; cohort studies are resource-intensive and may alter disease natural history, while sentinel surveillance underestimates incidence in the population. Hybrid surveillance, whereby facility-based surveillance is paired with a community-based healthcare utilization assessment, represents an alternative approach to generating population-based disease incidence estimates with moderate resource investments. Here, we discuss this method in the context of the Surveillance for Enteric Fever in Asia Project (SEAP) study. We describe how data are collected and utilized to adjust enteric fever incidence for blood culture sensitivity, facility-based enrollment, …

Serous Cystadenoma Of Pancreas : A Clinicopathologic Experience Of 23 Cases From A Major Tertiary Care Center, Muhammad Usman Tariq, Zubair Ahmad, Jamshid Abdul Ghafar, Nasir Ud Din

Department of Pathology and Laboratory Medicine

Background: Serous cystadenomas of pancreas are rare benign epithelial neoplasms, which predominantly occur in the pancreatic body and tail of elderly females. Majority of these tumors have microcystic appearance. Macrocystic and solid variants have also been described. A number of more aggressive cystic pancreatic lesions are included in the differential diagnosis. Distinction from such lesions is important for optimal management.
Objective: Our aim was to study the clinical and histological features of serous cystadenomas which would be helpful in making their correct diagnosis and understanding their behavior.
Methods: We reviewed 23 cases of serous cystadenomas diagnosed in our institution between …

Oral Ondansetron Administration To Nondehydrated Children With Diarrhea And Associated Vomiting In Emergency Departments In Pakistan: A Randomized Controlled Trial, Stephen B. Freedman, Sajid Bashir Soofi, Andrew R. Willan, Sarah Williamson Urquhart, Noshad Ali, Jianling Xie, Fady Dawoud, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Study objective: We determine whether single-dose oral ondansetron administration to children with vomiting as a result of acute gastroenteritis without dehydration reduces administration of intravenous fluid rehydration.
Methods: In this 2-hospital, double-blind, placebo-controlled, emergency department–based, randomized trial conducted in Karachi Pakistan, we recruited children aged 0.5 to 5.0 years, without dehydration, who had diarrhea and greater than or equal to 1 episode of vomiting within 4 hours of arrival. Patients were randomly assigned (1:1), through an Internet-based randomization service using a stratified variable-block randomization scheme, to single-dose oral ondansetron or placebo. The primary endpoint was intravenous rehydration (administration of 20 …

Surgical Management Of Metastatic Lesions Of Proximal Femur And The Hip, Mujahid Jamil Khattak, Umair Ashraf, Zohaib Nawaz, Shahryar Noordin, Masood Umer

Section of Orthopaedic Surgery

Metastatic bony lesions involving proximal femur and hip joint pose a challenge to orthopedic surgeons. Lesions in this important weight-bearing zone of the femur weaken its ability to sustain load causing pain and impending pathologic fracture. These Patients warrant multidisciplinary approach including orthopedic surgeons, oncologist and medical specialties. Management of these lesions has evolved over the last 60 years from benign neglect to internal fixation and recently to prosthetic reconstruction for optimum function. Decision for surgical approach requires consideration for location of the lesion, presence of a fracture, tumor type, cortical destruction, patient's life expectancy, patient preferences and the expected …

Ankle Arthrodesis Using Ilizarov Ring Fixator: A Primary Or Salvage Procedure?: An Analysis Of Twenty Cases, Obada Hasan, Shah Fahad, S. Sattar, Masood Umer, Haroon Rashid

Section of Orthopaedic Surgery

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients.
Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in …

Nursing And #Metoo, Nasreen Rafiq, Shyrose Sultan, Afsheen Hirani, Samreen Verasiya, Zainish Hajani, Neelam Rafiq

School of Nursing & Midwifery

The year 2018 revealed a number of sexual harassment stories into public conversation as part of the #MeToo movement. The campaign has relatively spread across all professions and work industries. Today, the society is already hypersensitive towards sexual talks, and the campaigns such as #MeeToo make it even more difficult to overlook these stories; it has challenged the demarcation of important and superfluous accusations which gives rise to various ethical dilemmas. Therefore, the #MeToo movement becomes significant to evaluate both sides of a coin, and assess a situation from various ethical paradigms in order to reach an ethically acceptable solution.

Mapping Maternal Mortality Rate Via Spatial Zero-Inflated Models For Count Data: A Case Study Of Facility-Based Maternal Deaths From Mozambique, Osvaldo Loquiha, Niel Hens, Leonardo Chavane, Marleen Temmerman, Nafissa Osman, Christel Faes, Marc Aerts

Obstetrics and Gynaecology, East Africa

Maternal mortality remains very high in Mozambique, with estimates from 2015 showing a maternal mortality ratio of 489 deaths per 100,000 live births, even though the rates tend to decrease since 1990. Pregnancy related hemorrhage, gestational hypertension and diseases such as malaria and HIV/AIDS are amongst the leading causes of maternal death in Mozambique, and a significant number of these deaths occur within health facilities. Often, the analysis of data on maternal mortality involves the use of counts of maternal deaths as outcome variable. Previously we showed that a class of hierarchical zero-inflated models were very successful in dealing with …

Radiological And Clinical Outcomes In Patients Undergoing Anterior Cervical Discectomy And Fusion: Comparing Titanium And Peek (Polyetheretherketone) Cages, Muhammad Junaid, Mamoon Ur Rashid, Syed Sarmad Bukhari, Mamoon Ahmed

Section of Neurosurgery

Objectives: To study clinical and radiological outcomes in patients who had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages for cervical disc prolapse.
Methods: This is a retrospective/non-randomized study which was conducted at the Combined Military Hospital Peshawar. Study interval was four years from 1st October, 2010 to 31st September, 2014. Total number of included patients were 149. All of the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages. All of the patients had plain MRI cervical spine done for diagnosis of anterior cervical …

963. Whole Blood Transcriptome Analysis Reveals Differences In Erythropoiesis And Neurologically Relevant Pathways Between Cerebral Malaria And Severe Malarial Anemia, Srinivas Nallandhighal, Gregory Park, Yen-Yi Ho, Robert Opoka, Chandy John, Tuan Tran

Paediatrics and Child Health, East Africa

Background: Plasmodium falciparum malaria can rapidly progress to severe disease that can lead to death if left untreated. Severe malaria cases commonly present as severe malarial anemia (SMA), defined in children as hemoglobin (Hb) <5 g/dL with parasitemia, or as cerebral malaria (CM), which manifests as parasitemia with acute neurological deficits and has an inpatient mortality rate of ~20%. The molecular and cellular processes that lead to CM and SMA are unclear.

Methods: In a cross-sectional study, we compared genome-wide transcription profiles of whole blood obtained from Ugandan children with acute CM (n = 17) or SMA (n = 17) and community children without P. falciparum infection (n = 12) who were enrolled in a parent cohort study of severe malaria. We determined the relationships between gene expression, hematological indices, and plasma biomarkers, including inflammatory cytokines. …

Genetics Of The Thrombomodulin-Endothelial Cell Protein C Receptor System And The Risk Of Early-Onset Ischemic Stroke, John W. Cole, Huichun Xu, Kathleen Ryan,, Thomas Jaworek, Nicole Dueke, Patrick Mcardle, Brady Gaynor,, Yu-Ching Cheng, Jeffrey O'Connell, Ayeesha Kamran Kamal

Section of Neurology

Background and Purpose: Polymorphisms in coagulation genes have been associated with early-onset ischemic stroke. Here we pursue an a priori hypothesis that genetic variation in the endothelial-based receptors of the thrombomodulin-protein C system (THBD and PROCR) may similarly be associated with early-onset ischemic stroke. We explored this hypothesis utilizing a multi-stage design of discovery and replication.

Methods: Discovery was performed in the Genetics-of-Early-Onset Stroke (GEOS) Study, a biracial population-based case-control study of ischemic stroke among men and women aged 15-49 including 829 cases of first ischemic stroke (42.2% African-American) and 850 age-comparable stroke-free controls (38.1% African-American). Twenty-four single-nucleotide-polymorphisms …

Port Site Parasitic Leiomyoma After Laparoscopic Myomectomy: A Case Report And Review Of The Literature, Felix Oindi, Steve Mutiso, Timona Obura

Obstetrics and Gynaecology, East Africa

Background: Uterine fibroids are the commonest benign gynecological tumors. Laparoscopic myomectomy is becoming increasingly popular as one of the surgical treatment options for symptomatic cases. Large tissues such as leiomyomas or even the uterus need to be morcellated in order to be retrieved from the abdominal cavity. Some of the morcellated fragments or small fibroids may be accidentally left in the abdominal cavity during the retrieval process. These may subsequently become implanted in the abdominal cavity, develop blood supply from the surrounding structures, and grow to form parasitic myomas with varied clinical presentation, depending on the location and size.

Case …

Levonorgestrel Only Emergency Contraceptive Use And Risk Of Ectopic Pregnancy In Eldoret Kenya: A Case-Control Study, Sahara Shurie, Edwin Were, Elkanah Omenge, Alfred Keter

Obstetrics and Gynaecology, East Africa

Introduction: ectopic pregnancy is one of the causes of maternal morbidity and mortality in Sub-Saharan Africa. Levonorgestrel (LNG) only emergency contraceptive pill is a well-established emergency contraceptive pill that is administered within 72 hours after unprotected intercourse. This study aimed at determining whether or not there is a significant association between levonorgestrel emergency contraceptive use and the occurrence of ectopic pregnancy.

Methods: case-control (1:3) study among 79 women with ectopic pregnancy (cases) matched against 237 women without (controls) at Moi Teaching and Referral Hospital in Eldoret, Kenya; Sociodemographic and clinical data were collected using a questionnaire. Association between ectopic pregnancy …

Tumour Treating Fields (Ttfs) For Paediatric Brain Tumours, Brain Metastases And Other Novel Applications, Farhan Arshad Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Tumour treating fields (TTFs) are now FDA approved for high grade glioma treatment. Novel application of this treatment modality is being assessed for paediatric brain tumours and intracranial metastatic disease. Clinical trials are being conducted to test the efficacy of this treatment modality as adjuvant therapy to current standard of care. Here we will discuss the existing literature on TTF its role in pathologies other than GBM. In addition, aspects of safety, compliance and cost are also discussed.

Large Mediastinal Mass In A 15-Year-Old Boy, Mariyam Gohar Ali, Ali Bin Sarwar Zubairi, Farah Naz Farid

Section of Pulmonary & Critical Care

Hyperimmunoglobulin E syndrome is a rare multisystem inherited disorder characterised by high serum IgE levels, skin disorder causing eczema, dermatitis, recurrent staphylococcal infections and pulmonary infections and various skeletal and connective tissue abnormalities. Common presentation is with recurrent skin and sinopulmonary infections. Several features unrelated to immune system such as characteristic facial features, hyperextensibility of joints, multiple bone fractures and craniosynostosis have been described in the literature. We describe a rare presentation of this disease with invasive aspergillosis presenting as mediastinal mass with extension to mediastinalstructures and pulmonary vasculature.

Rare Case Of Giant Asymptomatic Left Coronary Artery Aneurysm Of 10 Cm Associated With Coronary Cameral Fistula, Ali Afzal, Mohamad Sharbatji, Hussain Nawaz, Muqeet Siddiqui

Section of Internal Medicine

A giant coronary artery aneurysm (CAA) associated with a coronary cameral fistula is an extremely rare finding. Most cases of CAAs are asymptomatic. The incidence of CAA varies between 0.3% to 5.3%. Due to advancements in diagnostic technologies, the incidence of CAA is on the rise. Even in the modern days of medical science, the clinical course of CAA is still unpredictable and the suitable timing for the treatment of CAA is still open to debate. We reported a case of a giant coronary artery aneurysm in a 38-year-old female, which was 9.4 x 9.7 x 9.2cm in size, arising …

Diagnostic Value Of Gauze Filtration Technique: A Comparison With Conventional Methods In A Diagnostic Laboratory In Pakistan, Naima Maqsood, Aymen Shakeel, Najia Karim Ghanchi, Ahmed Raheem Buksh, ,Feroz Zaheruddin, Ghazala Jabeen, Afsheen Raza, Mohammad A. Beg

Section of Internal Medicine

Background: Intestinal parasites cause significant morbidity and impact human development with an enormous global burden. Diagnosis of intestinal parasites by conventional methods has several limitations. The gauze filtration technique is a relatively simple method that has been shown to identify intestinal parasites with a high sensitivity and specificity. The aim of this study was to determine the diagnostic value of this technique as compared to more conventional methods in a large acclaimed laboratory within Pakistan.

Methods: A total of 50 stool samples collected for routine diagnostic workup from patients age between 2-70 years were collected from the parasitology section of …

Novel Public-Private Partnerships To Address The Double Burden Of Malnutrition, Adam Drewnowski, Benjamin Caballero, Jai K. Das, Jeff French, Andrew M. Prentice, Lisa R. Fries, Tessa M Van Koperen, Petra Klassen-Wigger, Barbara J. Rolls

Department of Paediatrics and Child Health

Public–private partnerships are an effective way to address the global double burden of malnutrition. While public–private partnerships operate in multiple forms, their leadership usually falls to governments, public health agencies, or nongovernmental organizations, with the private sector taking a subordinate role. The rapid ascent of social media and mass communications worldwide has provided a disruptive technology for new nutrition intervention programs. A new model, provisionally called private–public engagement, takes advantage of social media, mass media, and integrated social marketing to reach parents, families, and communities directly. These new private–public engagement initiatives need to be managed in ways suggested for public–private …