Digital Commons Network^™

Immunity And Field Efficacy Of Type 2-Containing Polio Vaccines After Cessation Of Trivalent Oral Polio Vaccine: A Population-Based Serological Study In Pakistan, Arie Voorman, Atif Habib, Imtiaz Hussain, Rana Muhammad Safdar, Jamal A. Ahmed, William C. Weldon, Imran Ahmed, Muhammad Umer, Jeffrey Partridge, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: In Pakistan and other countries using oral polio vaccine (OPV), immunity to type 2 poliovirus is now maintained by a single dose of inactivated polio vaccine (IPV) in routine immunization, supplemented in outbreak settings by monovalent OPV type 2 (mOPV2) and IPV. While well-studied in clinical trials, population protection against poliovirus type 2 achieved in routine and outbreak settings is generally unknown.
Methods: We conducted two phases of a population-based serological survey of 7940 children aged 6-11 months old, between November 2016 and October 2017 from 13 polio high-risk locations in Pakistan.
Results: Type 2 seroprevalence was 50% among …

How Nutrition Can Help To Fight Against Covid-19 Pandemic, Faseeha Aman, Sadia Masood

Section of Internal Medicine

Currently Covid-19 pandemic is a leading challenge across the globe. It is mandatory to attain and maintain good nutritional status to fight against virus. Nutritional status of individual is affected by several factors such as age, sex, health status, life style and medications. Nutritional status of individuals has been used as resilience towards destabilization during this COVID-19 pandemic. Optimal nutrition and dietary nutrient intake impact the immune system, therefore the only sustainable way to survive in current context is to strengthen the immune system. There is no evidence found that supplement can cure the immune system except Vit C, which …

Can Technology Help Improve Diarrhoea Management?, Zulfiqar Ahmed Bhutta

Woman and Child Health

No abstract provided.

Chloroquine Administration In Breastfeeding Mothers Associates With Increased Hiv-1 Plasma Viral Loads, William A. Paxton, Marloes A. Naarding, Ferdinand Wnm Wnm Wit, Nienke J. Veldhuijzen, Matthew F. Chersich, Brigitte Kankindi Kankindi, Rene Douma A. Douma, Samuel Tuyizere, Suzanne Jurriaans, Stanley Luchters

Population Health, East Africa

Chloroquine (CQ) and Hydroxychloroquine (HCQ) have been proposed to be effective at treating COVID-19 patients. We, and others, have previously reported on the capacity of CQ to reduce HIV-1 replication in vitro. We tested CQ administration in post-partum mothers on influencing HIV-1 viral loads in human milk as a means of lowering mother to child transmission. A Phase I/II, randomized, placebo-controlled study to evaluate chloroquine administration to reduce HIV-1 RNA levels in human milk: the CHARGE study. Thirty HIV-1 positive pregnant Rwandese women (CQ n = 20; placebo n = 10) were enrolled in a 16-week study, with the treatment …

Draft Genome Sequences Of Two Extensively Drug-Resistant Strains Of Acinetobacter Baumannii Isolated From Clinical Samples In Pakistan, Sara Lomonaco, Matthew A. Crawford, Christine Lascols, Debra J. Fisher, Kevin Anderson, David R. Hodge, Segaran P. Pillai, Stephen A. Morse, Erum Khan, Molly A. Hughes, Marc W. Allard, Shashi K. Sharma

Department of Pathology and Laboratory Medicine

Infections in immunocompromised patients that are caused by extensively drug-resistant (XDR) Acinetobacter baumannii strains have been increasingly reported worldwide. In particular, carbapenem-resistant A. baumannii strains are a prominent cause of health care-associated infections. Here, we report draft genome assemblies for two clinical XDR A. baumannii isolates obtained from hospitalized patients in Pakistan.

Clinical Features, Diagnosis And Management Of Covid-19 Patients In The Outdoor Setting, Bushra Jamil

Department of Medicine

In a brief span of a few months, coronavirus disease (COVID-19) pandemic has brought a major paradigm shift in operation of clinical services around the world. Infection may be mild, moderate or severe; many remain asymptomatic. High burden of non-communicable and communicable diseases theoretically puts Pakistani population at increased risk of severe COVID-19 infection. Considering the universal risk of infection, the outpatient services in Pakistan need to be redesigned. Starting with risk assessment of the facility and provision of a dedicated telephone connection, structure and workflow need to be redesigned in order to minimise risk of exposure to healthcare professionals, …

Efforts To Improve Diagnosis Of Bacteraemia By Reducing Blood Culture Contamination In An Emergency Department: Strategies And Outcome, Najma Shaheen, Mohammad Zeeshan, Naima Fasih, Joveria Farooqi, Kausar Jabeen, Seema Irfan

Department of Pathology and Laboratory Medicine

Objective: To assess the strategies and outcome for reducing blood culture contamination in order to improve the diagnosis of bacteraemia.
Methods: The interventional study was conducted at a tertiary care hospital in Karachi from January 1, 2013, to December 31, 2016. The blood culture contamination data related to the first year of the study was taken as the baseline pre-intervention data. Strategies were planned as intervention for improvement by consolidating training and education in the form of dedicated lectures, practising on mannequins and developing in-house video, replacing povidone with 2% chlorhexidine preparation spray plus 70% isopropyl alcohol swabs and inducting …

Precise Pregnancy Cohort: Challenges And Strategies In Setting Up A Biorepository In Sub-Saharan Africa, Rachel Craik, Donna Russell, Rachel M. Tribe, Marleen Temmerman, Angela Koech, Patricia Okiro, Geoffrey Omuse, Sikolia Wanyonyi

Obstetrics and Gynaecology, East Africa

Background and objective: PRECISE is a population-based, prospective pregnancy cohort study designed for deep phenotyping of pregnancies in women with placenta-related disorders, and in healthy controls. The PRECISE Network is recruiting ~ 10,000 pregnant women in three countries (The Gambia, Kenya, and Mozambique) representing sub-Saharan Africa. The principal aim is to improve our understanding of pre-eclampsia, fetal growth restriction and stillbirth. This involves the creation of a highly curated biorepository for state of the art discovery science and a rich database of antenatal variables and maternal and neonatal outcomes. Our overarching aim is to provide large sample numbers with …

The Precise (Pregnancy Care Integrating Translational Science, Everywhere) Network’S First Protocol: Deep Phenotyping In Three Sub-Saharan African Countries, Peter Von Dadelszen, Meriel Flint-O’Kane, Lucilla Poston, Rachel Craik, Donna Russell, Rachel M. Tribe, Umberto D’Alessandro, Marleen Temmerman, Angela Koech, Anna Roca

Obstetrics and Gynaecology, East Africa

Background: The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network is a new and broadly-based group of research scientists and health advocates based in the UK, Africa and North America.

Methods: This paper describes the protocol that underpins the clinical research activity of the Network, so that the investigators, and broader global health community, can have access to ‘deep phenotyping’ (social determinants of health, demographic and clinical parameters, placental biology and agnostic discovery biology) of women as they advance through pregnancy to the end of the puerperium, whether those pregnancies have normal outcomes or are complicated by one/more of the …

Nepal's Response To Contain Covid-19 Infection, Rano Mal Piryani, Suneel Piryani, Jay Narayan Shah

Community Health Sciences

Nepal is a landlocked country bordering two most populous countries, India and China. Nepal shares open border with India from three sides, east, south and west. And, in north with China, where the novel coronavirus infection (CVOVID-19) began in late December 2019. The first confirmed imported case in Nepal was reported in 2nd week of January 2020. The initial response of Nepal to COVID-19 were comparably slow but country geared efforts after it was declared a 'global pandemic' by WHO on 11 March, 2020. Government of Nepal's steps from 18 March, 2020 led to partial lock down and countrywide lockdown …

School-Based Interventions To Promote Personal And Environmental Hygiene Practices Among Children In Pakistan: Protocol For A Mixed Methods Study, Nousheen Pradhan, Waliyah Mughis, Tazeen S. Ali, Maleeha Naseem, Rozina Karmaliani Professor

Community Health Sciences

Background: Poor personal hygiene and inadequate sanitation practices among young children leads to communicable diseases. There remains a gap in the holistic assessment of school children's hygiene literacy, practices and effectiveness of school-based hygiene interventions in Pakistan. Therefore, a school-based intervention protocol has been designed to promote personal and environmental hygiene practices for primary school children. Towards improving children's hygiene behaviors, the study will also focus on enhancing mothers' hygiene knowledge and practices.
Methods: Using quasi-experimental design with mixed methods data collection approaches, this study will be conducted in schools located in an urban squatter settlements in Pakistan. To assess …

Drug Induced Liver Injury Is Associated With High Mortality- A Study From A Tertiary Care Hospital In Pakistan, Adeel Abid, Faryal Subhani, Farhana Kayani, Safia Awan, Shahab Abid

Medical College Documents

Background and aim: In light of few established drug induced liver injury (DILI) registries, this study aims to evaluate the clinical spectrum and predictors of mortality and morbidity of hospitalized patients with suspected DILI.
Patients and methods: DILI cases were identified and categorized on basis of COIMS/RUCAM score and the exclusion of other liver diseases. Clinical and laboratory parameters were analyzed to identify the predictors of morbidity (prolonged hospital stay > 5 days) and mortality.
Results: Out of 462 patients, there were 264 (57.6%) males and the mean age of the cohort was 50.83 years (range: 20-94 years). DILI was classified …

Delivering Infectious Disease Interventions To Women And Children In Conflict Settings: A Systematic Review, Sarah Meteke, Marianne Stefopulos, Daina Als, Michelle Gaffey, Mahdis Kamali, Fahad J. Siddiqui, Mariella Munyuzangabo, Reena P. Jain, Shailja Shah, Amruta Radhakrishnan, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Conflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents.
Methods: We searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery …

Inspire : Vol 3, Issue 4, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From the Chair
• COVID-19: Crisis Inspiring Virtual Innovations
• Nephrology and Urology Simulation-based Workshops
• Featured Faculty: Dr Saad Shafqat
• “Take exemplary care of your patients. If you do that with honesty and ability, all good things will follow”
• Publications

Global Burden Of Respiratory Infections Associated With Seasonal Influenza In Children Under 5 Years In 2018: A Systematic Review And Modelling Study, Xin Wang, You Li, Katherine L. O'Brien, Qalab Abbas, Syed Asad Ali, Respiratory Virus Global Epidemiology Network, Mohammad Tahir Yousafzai, Zulfiqar Ahmed Bhutta, Sajid Bashir Soofi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: Seasonal influenza virus is a common cause of acute lower respiratory infection (ALRI) in young children. In 2008, we estimated that 20 million influenza-virus-associated ALRI and 1 million influenza-virus-associated severe ALRI occurred in children under 5 years globally. Despite this substantial burden, only a few low-income and middle-income countries have adopted routine influenza vaccination policies for children and, where present, these have achieved only low or unknown levels of vaccine uptake. Moreover, the influenza burden might have changed due to the emergence and circulation of influenza A/H1N1pdm09. We aimed to incorporate new data to update estimates of the global …

Paediatric Respiratory Isolation: A Challenge For A Secondary Care Hospital! A Service Innovation Project, Nadia Mohammad, Shireen Mohammad, Arjumand Sohaila, Syed Mohammad Yousuf, Adnan Khan, Rahila Meghani, Kashif Sajwani, Khalil Ahmad, Ali Faisal Saleem Dr, Pawan Vash

Department of Paediatrics and Child Health

Objective: The aim of this project was to broaden the secondary care hospital's scope of services and provide safe, effective and quality care for the patient presenting with measles.
Methods: Six Sigma DMAIC [define measure, analyze, improve, and control (DMAIC)] methodology was used in this quality improvement project. The quality project was started in October 2015 using a Gantt chart quality tool.
Results: The paediatric team with the support of administration of the hospital has established isolation rooms and devised a policy for the care and management of patient with airborne infection to avoid cross transmission. During six months period …

Evidence Of The Covid-19 Virus Targeting The Cns: Tissue Distribution, Host-Virus Interaction, And Proposed Neurotropic Mechanisms, Abdul Mannan Baig, Areeba Khaleeq, Usman Ali, Hira Syeda

Department of Biological & Biomedical Sciences

The recent outbreak of coronavirus infectious disease 2019 (COVID-19) has gripped the world with apprehension and has evoked a scare of epic proportion regarding its potential to spread and infect humans worldwide. As we are in the midst of an ongoing pandemic of COVID-19, scientists are struggling to understand how it resembles and differs from the severe acute respiratory syndrome coronavirus (SARS-CoV) at the genomic and transcriptomic level. In a short time following the outbreak, it has been shown that, similar to SARS-CoV, COVID-19 virus exploits the angiotensin-converting enzyme 2 (ACE2) receptor to gain entry inside the cells. This finding …

Computer Aided Detection Of Tuberculosis On Chest Radiographs: An Evaluation Of The Cad4tb V6 System, Keelin Murphy, Shifa Salman Habib, Syed Mohammad Asad Zaidi, Saira Khowaja, Aamir Khan, Jaime Melendez, Ernst T. Scholten, Farhan Amad, Steven Schalekamp, Maurits Verhagen

Community Health Sciences

There is a growing interest in the automated analysis of chest X-Ray (CXR) as a sensitive and inexpensive means of screening susceptible populations for pulmonary tuberculosis. In this work we evaluate the latest version of CAD4TB, a commercial software platform designed for this purpose. Version 6 of CAD4TB was released in 2018 and is here tested on a fully independent dataset of 5565 CXR images with GeneXpert (Xpert) sputum test results available (854 Xpert positive subjects). A subset of 500 subjects (50% Xpert positive) was reviewed and annotated by 5 expert observers independently to obtain a radiological reference standard. The …

Comparison Of Clinical Presentation And Out-Comes Of Chikungunya And Dengue Virus Infections In Patients With Acute Undifferentiated Febrile Illness From The Sindh Region Of Pakistan, Uzma Shahid, Joveria Farooqi, Kelli L. Barr, Syed Faisal Mahmood, Bushra Jamil, Kehkashan Imtiaz, Zahida Azizullah, Faisal Malik, Dhani Prakoso, Maureen T. Long, E. Khan

Department of Pathology and Laboratory Medicine

Background: Arboviruses are a cause of acute febrile illness and outbreaks worldwide. Recent outbreaks of Chikungunya virus (CHIKV) in dengue endemic areas have alarmed clinicians as unique clinical features differentiating CHIKV from Dengue virus (DENV) are limited. This has complicated diagnostic efforts especially in resource limited countries where lab testing is not easily available. Therefore, it is essential to analyse and compare clinical features of laboratory confirmed cases to assist clinicians in suspecting possible CHIKV infection at time of clinical presentation.
Methodology: A prospective point prevalence study was conducted, with the hypothesis that not all patients presenting with clinical suspicion …

Press Release - Covid-19 16 Mar 2020, Aga Khan University Hospital

COVID-19 Archive Project

• COVID-19 Press Statement

Etiology, Clinical, Radiological, And Microbiological Profile Of Patients With Non-Cystic Fibrosis Bronchiectasis At A Tertiary Care Hospital Of Pakistan, Nadia Sharif, Mirza Saifullah Baig, Sana Sharif, Muhammad Irfan

Section of Pulmonary & Critical Care

Objectives: To identify the etiology of non-cystic fibrosis bronchiectasis (NCFB), to assess the clinical presentation, radiological findings, and microbiological profile of patients presenting with a diagnosis of bronchiectasis in a tertiary care center of Pakistan.
Methods: This was a prospective observational cohort study where patients with a diagnosis of bronchiectasis proven by high-resolution computed tomography (HRCT) were evaluated for etiology, clinical characteristics, microbiology, radiology, spirometric profile, and in-hospital outcomes.
Results: During the study period, 196 patients were diagnosed with NCFB. The majority of the patients were men 76.5% (n = 150) and 83.6% (n = 163) of the total patients …

Combating Antibiotic Resistance Using Guidelines And Enhanced Stewardship In Kenya: A Protocol For An Implementation Science Approach, Jesse Gitaka, Moses Kamita, Dominic Mureithi, Davies Ndegwa, Moses Masika, Geoffrey Omuse, Moses Ngari, Francis Makokha, Peter Mwaura, Ronald Mathai, Francis Muregi, Matilu Mwau

Pathology, East Africa

Introduction: Antimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of …

Adherence To Universal Precautions And Associated Factors Among Nurses Caring For Critically Ill Patients In Dar Es Salaam Tanzania, Salma A. Wibonela, Columba Mbekenga, Fatina B. Ramadhani, Ally Mwanga, Pedro Palangyo

School of Nursing & Midwifery, East Africa

Background: Globally, it is known that heath care workers particularly in critical care settings are at higher risk of occupational exposure to infections. Surveillance systems to monitor body fluid exposure have been established in developed world. However, such systems are not available and consequently, exposure to body fluids is rarely reported, documented and monitored in many African countries.

Objectives: To assess knowledge, practice and factors influencing adherence of Universal Precautions of infection prevention among nurses at Muhimbili national hospital and Muhimbili orthopaedic institute Dar es salaam Tanzania.

Design: Quantitative cross-sectional and observational study. SPSS was used for data …

Neurological Involvement In Covid-19 Infections; Pathophysiology, Presentation And Outcome., Dureshahwar Kanwar, Muhammad Imran, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Severe acute respiratory syndrome corona virus 2 (SARS CoV 2) seems to display an increasing affinity for the nervous system. The ongoing pandemic has made evident that diverse neurological manifestations may occur with COVID 19. Headache and dizziness remain the most common symptoms however stroke, seizures, encephalopathy, neuropathy and skeletal muscle injury may be seen. An increasing number of patients report initial anosmia and ageusia. Tendency for serious illness is believed to be in the elderly or people with a history of diabetes, high blood pressure and heart disease. Many patients on immunosuppressive therapies such as multiple sclerosis, myasthenia gravis …

Family Medicine In Tanzania: Seize The Moment, Riaz Ratansi, Bernhard M. Gaede

Faculty of Health Sciences, East Africa

In the context of addressing the pressing health needs for the global population, the World Health Organization has repeatedly called for universal health coverage (UHC) to be prioritised by its member countries. This is to be achieved through a high-quality primary health care (PHC) approach that provides comprehensive and integrated generalist care as close to where people live as well as links the clinical care to health promotion and disease prevention. In this paper, we argue for the introduction of family medicines as a critical player in the healthcare system of Tanzania to strengthen the strategies towards UHC. The paper …

Labrad : Vol 46, Issue 1 - March 2020, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Role of Immunofluorescence Studies in the Diagnosis of Autoimmune Disorders
• Cystathionine Beta-Synthase Deficiency
• Treatment of Factor VIII Inhibitor
• Effective Internal Communication in Laboratories
• Digital Breast Tomosynthesis
• Overview of Common Myeloproliferative Neoplasms
• Clinical Significance of free Androgen Index (FAI)
• Radiology Quiz
• The Best of the Past
• Section Of Histopathology: Newer Horizons
• A Webinar Series ‘Rare Links’
• A Look into the Eye can Unleash Vital Diagnostic Pearls for 32 Rare Disorders
• Lab & Rad Mesh up for the Early Recognition of Rare Disorders
• Polaroid

Pharmacy Newsletter : March 2020, Pharmacy Department

Department of Pharmacy Archives

Content:

• Roles of Pharmacist during the COVID‐19 Pandemic
• Drug Interaction Update
• ToxTalk | Bleach Ingestion
• COVID-19- Recommended Practice
• Drug Induced Nutrient & Vitamin Deficiency

Chikungunya Encephalitis: Usual Presentation At An Unusual Time. A Case Report, Muhammad Owais Hashmat, Dureshahwar Kanwar, Iffat Khanum Khanum

Pakistan Journal of Neurological Sciences (PJNS)

CHIK is an arboviral infection caused by chikungunya virus transmitted by Aedes mosquito worldwide. It usually manifests as a self-limiting acute febrile illness with rash, body ache and severe polyarthralgia; in some patients, symptoms persist up to months or even years. Neurological manifestations are relatively uncommon. In recent years Pakistan and other South East Asian countries have been hit several times by its epidemics1. We report a case of a middle-aged male who presented in our hospital with acute febrile illness along with neurological manifestations. Extensive laboratory investigations were done and he was diagnosed with seropositive CHIKV. He was treated …

A Descriptive Study Of Double Burden Of Malnutrition In Mothers Of Children With Severe Acute Malnutrition Admitted In Children Hospital And Institute Of Child Health, Multan, Saadia Khan, Umme Ammara, Reema Arshad, Farah Naz, Kamran Ishfaq

Department of Paediatrics and Child Health

Objective: To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers.
Methods: The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined …

Post Tuberculosis Treatment Infectious Complications, Desmond Hsu, Muhammad Irfan, Kauser Jabeen, Nousheen Iqbal, Rumina Hasan, Giovanni Battista Migliori, Alimuddin Zumla, Dina Visca, Rosella Centis, Simon Tiberi

Department of Pathology and Laboratory Medicine

Following greater attention and follow-up of patients with treated pulmonary tuberculosis (TB), it has emerged that infections are more likely to occur in this cohort of patients. This comes as no surprise, as pulmonary TB is a destructive process that leads to cicatrization, alteration of parenchyma, bronchiectasis, and scarring of the lung, with reduction of lung volumes and an impact on pulmonary function. In addition to relapse and re-infection with TB, other pathogens are increasingly recognized in post-TB patients. This paper serves as a summary and guide on how to approach the post-TB patient with new signs and symptoms of …