Digital Commons Network^™

Non-Tuberculous Mycobacterial Infections-A Neglected And Emerging Problem, Imran Ahmed, Simon Tiberi, Joveria Farooqi, Kauser Jabeen, Dorothy Yeboah-Manu, Giovanni Battista Migliori, Rumina Hasan

Department of Pathology and Laboratory Medicine

Non-tuberculous mycobacteria (NTM) are ubiquitous dwellers of environmental niches and are an established cause of natural and nosocomial infections. The incidence of NTM infections is rising owing to a growing population of immunocompromised and vulnerable individuals, complex medical and surgical procedures, as well as increased awareness and diagnostic capabilities. The prevalence of different NTM varies between continents, regions, and countries. The true global burden of pulmonary and extrapulmonary disease is unknown and estimates are subject to under and/or over-estimation. Diagnosis requires confirmation by isolation of NTM along with clinical and radiological criteria, which may be suboptimal at all levels. Susceptibility …

The Aga Khan University Hospital, Karachi Today Confirmed Its First Case Of The Coronavirus Disease, Aga Khan University Hospital

COVID-19 Archive Project

• The Aga Khan University Hospital - COVID-19 Update
• Aga Khan University Hospital confirmed its first case of Coronavirus Disease (COVID-19). Highest standards of international care and strictest infection control protocols are being enforced with no risk of transmission of the virus to staff, students and other patients.

Hiv Pre‐Exposure Prophylaxis For Female Sex Workers: Ensuring Women’S Family Planning Needs Are Not Left Behind, Anna L. Bowring, Frances H Ampt, Sheree Schwartz, Mark A. Stoove, Stanley Luchters, Stefan Baral, Margaret Hellard

Population Health, East Africa

Introduction: Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unin- tended pregnancy. Pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs.

Discussion: FSWs have high unmet need for effective contraception and unintended pregnancy is common in …

Prevalence And Determinants Of Anemia Among Women Of Reproductive Age In Developing Countries, Sumera Aziz Ali, Umber S. Khan, Anam Shahil Feroz

Community Health Sciences

Anemia is one of the major causes of maternal mortality and morbidity across the globe, affecting around two-thirds of pregnant women in developing countries. The objective of this study was to synthesise study findings regarding the prevalence and determinants of anemia among women of reproductive age in developing countries. A total of 28 articles were reviewed by two authors for preliminary screening after removing overlapping information. Finally, 15 studies conducted from 2000 to 2015 were included in the review. The average prevalence of anemia was found to be 46.5% with a range of 18.1% to 75% in different studies. Factors …

Inspire : Vol 4, Issue 2, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message from the Chair
• Medicine at National and International Forums
• MoU signing ceremony at KP
• Virtual Seminar Multiple sclerosis and COVID-19 update
• EUS Webinar: Can EUS Replace ERCP?
• Tribute to COVID-19 warriors
• Neurology Section meets the new CEO-AKUH!
• Warm Welcome to Pulmonology section Residents
• In-depth- featuring Dr Sadia Masood
• Featured Faculty: Dr. Zaigham Abbas “ ..strive to excel in a particular field rather than pursuing too many goals so that the world may recognize you as authorities in your field”
• What are Academics Around the World Reading This Month?
• Publications

Orthograde Apical Plug In A Traumatized Tooth With Necrotic Pulp And Immature Apex Using Calcium Silicate Cement: A Case Report, Shizrah Jamal, Fahad Umer

Section of Dental-Oral Maxillofacial Surgery

This case report describes dental management of a 15- year-old boy, undergoing treatment for Thalassaemia Major and Acute Myeloid Leukaemia with bone marrow transplant and immuno-suppressants. During the course of his treatment the patient developed a swelling in anterior maxilla and therefore was referred by the primary physician for evaluation. This case report highlights the management of medically compromised patients in a tertiary care hospital in which apexification was carried out in a permanent immature tooth utilizing MTA as an immediate apical plug.

Diarrhoeal Disease And Subsequent Risk Of Death In Infants And Children Residing In Low-Income And Middle-Income Countries: Analysis Of The Gems Case-Control Study And 12-Month Gems-1a Follow-On Study, Myron M. Levine, Dilruba Nasrin, Sozinho Acácio, Quique Bassat, Helen Powell, Sharon M. Tennant, Samba O. Sow, Anita K. M. Zaidi, Shahida Qureshi, Farheen Quadri

Department of Paediatrics and Child Health

Background: The Global Enteric Multicenter Study (GEMS) was a 3-year case-control study that measured the burden, aetiology, and consequences of moderate-to-severe diarrhoea (MSD) in children aged 0-59 months. GEMS-1A, a 12-month follow-on study, comprised two parallel case-control studies, one assessing MSD and the other less-severe diarrhoea (LSD). In this report, we analyse the risk of death with each diarrhoea type and the specific pathogens associated with fatal outcomes.
Methods: GEMS was a prospective, age-stratified, matched case-control study done at seven sites in Africa and Asia. Children aged 0-59 months with MSD seeking care at sentinel health centres were recruited along …

A Multicenter Case Control Study Of Association Of Vitamin D With Breast Cancer Among Women In Karachi, Pakistan, Uzma Shamsi, Shaista Khan, Syed Iqbal Azam, Aysha Habib, Amir Maqbool, Mohammad Hanif, Tiffany Gill, Romaina Iqbal, David Callen

Community Health Sciences

Background: The prevalence of vitamin D inadequacy and breast cancer are both high among women living in Karachi, Pakistan.
Methods: A matched case control study was conducted in two hospitals of Karachi, Pakistan to evaluate the association of vitamin D (serum 25-hydroxyvitamin D) concentrations, vitamin D supplementation and sun exposure with breast cancer among Pakistani women. A total of 411 newly diagnosed histologically confirmed primary breast cancer cases were enrolled and 784 controls, free of breast and any other cancers, were matched by age (year of birth ± 5 years), residence in the same geographic area and study site. Information …

Neurodevelopment Outcome Of Neonates Treated With Intraventricular Colistin For Ventriculitis Caused By Multiple Drug-Resistant Pathogens-A Case Series, Kashif Hussain, Muhammad Sohail Salat, Gul Ambreen, Javaid Iqbal

Department of Biological & Biomedical Sciences

Background: Multiple-drug-resistant Gram-negative bacteria (MDR-GNB)-associated neonatal ventriculitis is a life-threatening complication that needs timely diagnosis and effective treatment with broad-spectrum antimicrobials in critical-care settings. Inadequate penetration of antibiotics through the blood-brain barrier also demands an intraventricular (IVT) route of administration. This study reports mortality and neurodevelopmental sequelae of neonates till 18 months of age, who received IVT-colistin for treating MDR-GNB associated ventriculitis.
Methods: In a case series of seven neonates with ventriculitis due to MDR-GNB at NICU of Aga Khan University Hospital, Pakistan, between June 2015 and 2018, we reviewed IVT-colistin therapy in critically ill neonates. Treatment outcomes were assessed …

Social Values For Health Technology Assessment In Canada: A Scoping Review Of Hepatitis C Screening, Diagnosis And Treatment, Caroline O'Keefe-Markman, Kristina Dawn Lea, Christopher Mccabe, Elaine Hyshka, Tania M. Bubela

Office of the Provost

Background: Health care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C. Approximately 240,000 individuals are infected with the hepatitis C virus (HCV) in Canada. Populations most affected by HCV include Indigenous people, people who inject drugs, immigrants and homeless or incarcerated populations as well as those born between 1946 and 1965. Curative but expensive drug regimens of novel direct acting antivirals (DAAs) are available. We aim to identify social values from academic literature for inclusion in health technology assessments.
Methods: We conducted a scoping review of academic literature to identify and analyze …

A Novel Histological Index For Evaluation Of Environmental Enteric Dysfunction Identifies Geographic-Specific Features Of Enteropathy Among Children With Suboptimal Growth, Ta-Chiang Liu, Kelley Vanbuskirk, Syed Asad Ali, M. Paul Kelly, Lori R. Holtz, Omer H. Yilmaz, Kamran Sadiq, Najeeha Talat Iqbal, Beatrice Amadi, Sana Syed

Department of Paediatrics and Child Health

Background: A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity.
Methods: Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists …

Using Mobile Phones To Improve Community Health Workers Performance In Low-And-Middle-Income Countries, Anam Shahil Feroz, Rawshan Jabeen, Sarah Saleem

Community Health Sciences

Background: In low-and-middle-income countries community health workers are the core component of the PHC system as they act as a liaison between the communities and the healthcare facilities. Evidence suggests that the services offered by these workers have helped in the decline of maternal and child morbidity and mortality rates and the burden of communicable and non-communicable diseases. However, the coverage and the overall progress towards achieving the SDG targets is very sluggish. The recent consensus concerning this current pace of progress, is that it relates to financial and human resources constraints. CHWs are overburdened as they are expected to …

Evaluation For Association Between Maternal Microbiota And Development Of Necrotizing Enterocolitis Or Gram-Negative Bacteremia In Preterm Infants, Mei Chi Quek

Master of Medicine in Paediatrics and Child Health

Background: Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. There is a need for a better understanding of the correlation of vaginal microbiota with adverse preterm outcomes. Our study aimed to explore how the vaginal microbiota influences the outcome of the preterm infants, determine whether fecal microbiota in premature infants differs from that in term infants, and explore the microbiota pattern in preterm neonates who received multiple antibiotics. Method: A prospective cohort design was used to enroll 33 women admitted in spontaneous labor between 25 to 36 weeks, and 33 controls matched for age and parity …

Outcomes Of Inpatients Hospitalized With Community Acquired Pneumonia, Jamila Nambafu

Master of Medicine in Internal Medicine

Background: The morbidity from lower respiratory tract infections has varied between age groups and from region to region. In sub-Saharan Africa, pneumonia remains the most frequent reason for adult hospitalization, with approximately 4 million episodes and about 200,000 deaths every year. Some of the attributable factors have been HIV pandemic, pulmonary tuberculosis, and poor socio-economic status. Objective: The main objective was to determine the morbidity of community-acquired pneumonia in patients admitted to a tertiary hospital in Nairobi, Kenya, between May 2019, and March 2020. The results are anticipated to help in informing protocols for the evaluation and treatment of community-acquired …

Etiologies Of Lower Respiratory Tract Infections Among Adult Patients Presenting To A Tertiary Institution In Nairobi, Mary Achakolong

Master of Medicine in Anatomic Pathology

Background: Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. Viral pathogens in isolation or as co-infections are an important cause of pneumonia and associated with several life threatening syndromes that warrant appropriate and timely lifesaving diagnosis. Many viral respiratory infections demonstrate substantial regional and seasonal variations which are poorly understood. In addition, there are very few studies in sub-Saharan Africa that have examined the role of viruses as causes of community acquired pneumonia. The availability of molecular techniques such as multiplex PCR that are much more sensitive than traditional methods and …

Neonatal Jaundice And Developmental Impairment Among Infants In Kilifi, Kenya, Dorcas N. Magai, Michael Mwaniki, Amina Abubakar, Shebe Mohammed, Anne L. Gordon, Raphael Kalu, Paul Mwangi, Hans M. Koot, Charles R. Newton

Institute for Human Development, East Africa

Background: Neonatal jaundice (NNJ) is common in sub‐Saharan Africa (SSA), and it is associated with sepsis. Despite the high incidence, little has been documented about developmental impairments associated with NNJ in SSA. In particular, it is not clear if sepsis is associated with greater impairment following NNJ.

Methods: We followed up 169 participants aged 12 months (57 cases and 112 controls) within the Kilifi Health Demographic Surveillance System. The diagnosis of NNJ was based on clinical laboratory measurement of total serum bilirubin on admission, whereas the developmental outcomes were assessed using the Developmental Milestones Checklist and Kilifi Development …

Perceptions Of Surgeons On Surgical Antibiotic Prophylaxis Use At Aga Khan Hospital, Dar Es Salaam., Elizabeth Elibariki Mmari

Master of Medicine in General Surgery

Introduction: Surgical site infections are a major cause of morbidity and mortality among operated patients. The use of antibiotic prophylaxis in prevention and reduction of incidence of surgical site infection is widespread. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medications for a single patient. Few studies have shown qualitatively factors influencing this, and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania. Objective: To describe the perceptions of surgeons …

Occult Hepatitis B Virus Infection In A Cohort Of Hiv Infected Antiretroviral Therapy Naïve Adults, Adil Suleiman Salyani

Master of Medicine in Internal Medicine

Background: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic to sub-Saharan Africa (SSA) with co-infection being common. Infection with HIV is a risk factor for occult hepatitis B virus infection (OBI), defined as presence of HBV deoxyribonucleic acid (DNA) in the absence of hepatitis B surface antigen (HBsAg). Occult hepatitis B virus infection is further classified based on HBV DNA level as true (/mL) or false (≥200 IU/mL). Presence of OBI is associated with development of liver cirrhosis and hepatocellular carcinoma (HCC). Objectives: The primary outcome was to determine the prevalence of OBI in anti-retroviral therapy (ART) …

Inspire : Vol 3, Issue 1, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From the Chair
• Global Fund TB Audit-Reviewing diagnostic algorithms used for clinical diagnosis of TB
• Student Research Forum’s 5th Journal Club
• Cardiac MRI experience at Duke Cardiovascular Magnetic Resonance Center
• Featured Faculty: Ms Safia Awan “Don’t ever give up on your dreams.”
• What are Academics Around the World Reading This Month?
• Publications

Exploring The Potential Of Artificial Intelligence And Machine Learning To Combat Covid-19 And Existing Opportunities For Lmic: A Scoping Review, Maleeha Naseem, Ramsha Akhund, Hajra Arshad, Muhammad Talal Ibrahim

Community Health Sciences

Background: In the face of the current time-sensitive COVID-19 pandemic, the limited capacity of healthcare systems resulted in an emerging need to develop newer methods to control the spread of the pandemic. Artificial Intelligence (AI), and Machine Learning (ML) have a vast potential to exponentially optimize health care research. The use of AI-driven tools in LMIC can help in eradicating health inequalities and decrease the burden on health systems.
Methods: The literature search for this Scoping review was conducted through the PubMed database using keywords: COVID-19, Artificial Intelligence (AI), Machine Learning (ML), and Low Middle-Income Countries (LMIC). Forty-three articles were …

Pre-Treatment Hiv-Drug Resistance Associated With Virologic Outcome Of First-Line Nnrti-Antiretroviral Therapy: A Cohort Study In Kenya, Ingrid A. Beck, Molly Levine, Christine J. Mcgrath, Steve Bii, Ross S. Milne, James M. Kingoo, Isaac So, Nina Andersen, Sandra Dross, Michael Chung

Internal Medicine, East Africa

Background: Pre-treatment HIV-drug-resistance (PDR) to WHO-recommended 1st-line non-nucleoside reverse transcriptase inhibitors (NNRTI)-based antiretroviral treatment (ART) is increasing in low-resource communities. We evaluated the risk of PDR on treatment failure if detected at single or multiple codons, at minority (2–9%) or higher (≥10%) frequencies during efavirenz- vs. nevirapine-ART.

Methods: We conducted a pooled analysis across three cohorts of Kenyans initiating 1st-line NNRTI-ART between 2006 and 2014. Mutations K103N, Y181C, G190A, M184V and K65R were detected by an oligonucleotide ligation assay (OLA) and confirmed by Sanger and next-generation sequencing (NGS). PDR was defined as detection of any mutation by OLA when confirmed …

The Impact Of Scaling Up Cervical Cancer Screening And Treatment Services Among Women Living With Hiv In Kenya: A Modelling Study, Pablo Noel Perez-Guzman, Michael Chung, Hugo De Vuyst, Shona Dalal, Kennedy K. Mutai, Karanja Muthoni, Bartilol Kigen, Timothy B. Hallett, Mikaela Smit

Internal Medicine, East Africa

Introduction: We aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18–65 in Kenya.

Methods: Mathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA) and cryotherapy (Cryo); (2) VIA and Cryo or loop excision electrical procedure (LEEP), as indicated; (3) human papillomavirus (HPV)-DNA testing and Cryo or LEEP; and (4) enhanced screening technologies (either same-day HPV-DNA testing or digitally enhanced VIA) and Cryo or LEEP. Outcomes measured were annual number of CC cases, deaths, screening and treatment interventions, …

Case Report Of Kikuchi-Fujimoto Disease From Sub-Saharan Africa: An Important Mimic Of Tuberculous Lymphadenitis, Karishma Sharma, Fredrick Otieno, Reena Shah

Internal Medicine, East Africa

Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced …

Inspire : Vol 3, Issue 1, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From the Chair
• Global Fund TB Audit-Reviewing diagnostic algorithms used for clinical diagnosis of TB
• Student Research Forum’s 5th Journal Club
• Medicine at National and International Forums
• Featured Faculty: Ms Safia Awan “Don’t ever give up on your dreams.”
• What are Academics Around the World Reading This Month?
• Publications

Clinical Characteristics Of Children With Epilepsy Managed At An Urban Hospital In Africa: A Retrospective Study, Pauline Samia, Arwen Barr, Subira B. Levi, Kirsten A. Donald, Jo M. Wilmshurst, Charles R. Newton

Paediatrics and Child Health, East Africa

Background: Most children with epilepsy reside in resource-limited regions such as sub-Saharan Africa, where the majority of studies have been conducted in rural areas with limited investigations. Medical records from children with epilepsy seen at an urban hospital in Kenya were examined to provide a comprehensive description of epilepsy in children from this hospital.
Methods: A retrospective observational study was conducted which involved reviewing medical records of 426 epilepsy patients (260 males and 166 females) aged 0 - 18 years, seen in Nairobi, Kenya between February 2011 and December 2014. Results: The most frequent age at presentation; documented in 29% …

Postpartum Endometritis And Infection Following Incomplete Or Complete Abortion: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Maternal Immunization Safety Data, C E. Rouse, L O. Eckert, F M. Muñoz, J S A. Stringer, S Kochhar, L Bartlett, M Sanicas, D J. Dudley, D M. Harper, Fyezah Jehan

Department of Paediatrics and Child Health

Abstract are not provided by the author/publisher

Deworming Children For Soil-Transmitted Helminths In Low And Middle-Income Countries: Systematic Review And Individual Participant Data Network Meta-Analysis, Vivian Andrea Welch, Alomgir Hossain, Elizabeth Ghogomu, Alison Riddle, Simon Cousens, Michelle Gaffey, Paul Arora, Robert Black, Donald Bundy, Zulfiqar Ahmed Bhutta

Woman and Child Health

Intestinal parasites affect millions of children globally. We aimed to assess effects of deworming children on nutritional and cognitive outcomes across potential effect modifiers using individual participant data (IPD). We searched multiple databases to 27 March 2018, grey literature, and other sources. We included randomised and quasi randomised trials of deworming compared to placebo or other nutritional interventions with data on baseline infection. We used a random-effects network meta-analysis with IPD and assessed overall quality, following a pre-specified protocol. We received IPD from 19 trials of STH deworming. Overall risk of bias was low. There were no statistically significant subgroup …

A Cross-Sectional Analysis Of Factors Associated With Detection Of Oncogenic Human Papillomavirus In Human Immunodeficiency Virus-Infected And Uninfected Kenyan Women, Aaron Ermel, P. Tonui, M. Titus, Y. Tong, N. Wong, J. Ong’Echa, Kapten Muthoka, Stephen Kiptoo, A. Moormann, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer is caused by oncogenic human papillomaviruses (HPV) and is one of the most common malignancies in women living in sub-Saharan Africa. Women infected with the human immunodeficiency virus (HIV) have a higher incidence of cervical cancer, but the full impact on HPV detection is not well understood, and associations of biological and behavioral factors with oncogenic HPV detection have not been fully examined. Therefore, a study was initiated to investigate factors that are associated with oncogenic HPV detection in Kenyan women.

Methods: Women without cervical dysplasia were enrolled in a longitudinal study. Data from enrollment are presented …

Cerebral Venous Sinus Thrombosis With Positive Dengue Serology, Sajid Hameed, Owais Hashmat, Mubashar Memon, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Dengue fever is a viral febrile illness caused by dengue virus and spread by Aedes mosquito worldwide. It usually manifests as an acute fever associated with body ache, skin rash, and thrombocytopenia. Neurological manifestations are relatively uncommon but well-known. We report a case of a 25-year-old male patient who presented to our hospital with acute febrile illness, headache, and vomiting. Extensive laboratory investigations were done and he was diagnosed with cerebral venous sinus thrombosis. Dengue serology was positive. He was treated with anticoagulation and hydration with complete recovery. The treatment with anticoagulation is challenging due to accompanying thrombocytopenia. Only two …

Protocol For An Economic Evaluation Alongside A Cluster Randomised Controlled Trial: Cost-Effectiveness Of Learning Clubs, A Multicomponent Intervention To Improve Women’S Health And Infant’S Health And Development In Vietnam, Trang Nguyen, Kim Sweeny, Thach Tran, Stanley Luchters, David B. Hipgrave, Sarah Hanieh, Tuan Tran, Ha Tran, Beverley-Ann Biggs

Population Health, East Africa

Introduction: Economic evaluations of complex interventions in early child development are required to guide policy and programme development, but a few are yet available.

Methods and analysis: Although significant gains have been made in maternal and child health in resource- constrained environments, this has mainly been concentrated on improving physical health. The Learning Clubs programme addresses both physical and mental child and maternal health. This study is an economic evaluation of a cluster randomised controlled trial of the impact of the Learning Clubs programme in Vietnam. It will be conducted from a societal perspective and aims to identify the cost-effectiveness …