Digital Commons Network^™

Determinants Of Campylobacter Infection And Association With Growth And Enteric Inflammation In Children Under 2 Years Of Age In Low-Resource Settings, Md Ahshanul Haque, James A. Platts-Mills, Estomih Mduma, Ladaporn Bodhidatta, Pascal Bessong, Sadia Shakoor, Gagandeep Kang, Margaret N. Kosek, Aldo A M Lima, Zulfiqar Ahmed Bhutta

Department of Pathology and Laboratory Medicine

Campylobacter species infections have been associated with malnutrition and intestinal inflammation among children in low-resource settings. However, it remains unclear whether that association is specific to Campylobacter jejuni/coli. The aim of this study was to assess the association between both all Campylobacter species infections and Campylobacter jejuni/coli infections on growth and enteric inflammation in children aged 1-24 months. We analyzed data from 1715 children followed from birth until 24 months of age in the MAL-ED birth cohort study, including detection of Campylobacter species by enzyme immunoassay and Campylobacter jejuni/coli by quantitative PCR in stool samples. Myeloperoxidase (MPO) concentration in stool, …

A Novel Training Simulator For Portable Ultrasound Identification Of Incorrect Newborn Endotracheal Tube Placement – Observational Diagnostic Accuracy Study Protocol, Hasan S. Merali, Mark O. Tessaro, Khushboo Q. Ali, Shaun K. Morris, Sajid Bashir Soofi, Shabina Ariff

Department of Paediatrics and Child Health

Background: Endotracheal tube (ETT) placement is a critical procedure for newborns that are unable to breathe. Inadvertent esophageal intubation can lead to oxygen deprivation and consequent permanent neurological impairment. Current standard-of-care methods to confirm ETT placement in neonates (auscultation, colorimetric capnography, and chest x-ray) are time consuming or unreliable, especially in the stressful resuscitation environment. Point-of-care ultrasound (POCUS) of the neck has recently emerged as a powerful tool for detecting esophageal ETTs. It is accurate and fast, and is also easy to learn and perform, especially on children.
Methods: This will be an observational diagnostic accuracy study consisting of two …

Microbial Profile And Antibiotic Susceptibility Trend In Postoperative Endophthalmitis: A 12-Year Review, Rashid Baig, Pushpa Bhawan Mal, Khabir Ahmed, Salman Naveed Sadiq, Sidra Zafar, Ghazala Jabeen, Saajan Kukreja

Section of Ophthalmology

Objective: To identify the microbial profile and susceptibility pattern of pathogens responsible for culture-proven postoperative endophthalmitis, and to investigate possible trends in both pathogens and antibiotic sensitivities.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of ophthalmology patients from January 1, 2005, to December 31, 2016. Culture and sensitivity reports of vitreous and aqueous humor samples from all the patients were retrieved from the medical record section of the hospital. SPSS 19 was used for data analysis.
Results: Of the samples of 202 patients with a mean age of 58.2±15.8 years, 106(52.5%) were …

An Investigation Into How Teachers Support Learners Reading In Grade One: A Study Of A Selected Primary School In Kenya, Kisumu County, Nyando Sub-County, Felix Okoth K'Ochuka

Master of Education

Reading is very important as it helps the learners to interpret information. Its foundation in young learners enhances their understanding of other subjects as well. It is for this reason that teachers should ensure that learners in grade one are taught how to articulate words well and be in a position to read. In order for reading to be meaningful to these learners, teachers should make it real and meaningful by using relevant resources when teaching so that learners can easily master them. The objective of this study was to find out which materials teachers use in teaching reading in …

Investigation Of Wellbeing Of Preschoolers In Shared School Environment, Hamza Shabani

Master of Education

Tanzania as a member of the international community is in the implementation of various conversion which advocates for the wellbeing of children at home and the school environment. This study investigated the wellbeing of preschoolers in a shared school environment at Kiomboi district Singida- Tanzania. The study employed a qualitative approach and case study designed in which interview, observation and document analysis were used as a tool of data collections. Two primary schools were involved in this study where respondents were two preschool teachers, one quality assurer and two heads of school were interviewed during data collection. Data revealed that …

Is There Value To Sub-Specialty Training In Sub-Saharan Africa?, Elkanah Omenge, S. E. Sinasac, Peter Itsura, Philip Tonui, B. Rosen, A. Covens

Obstetrics and Gynaecology, East Africa

Over the past three decades, Africa has focused on combatting infectious diseases, such as tuberculosis, malaria, and HIV/ AIDS. As treatment strategies for infectious diseases have improved over time, life expectancy has increased, shifting the burden to chronic diseases, such as cancer. The WHO has now identified non-communicable diseases, including cancer, as the new epidemic in sub-Saharan Africa1. Cancer incidence and mortality are increasing rapidly in low and middle-income countries (LMIC) as compared to high-income countries. By 2020, it is predicted that 70% of all new cancers worldwide will occur in LMIC2. In 2012 850 000 new cancers were diagnosed …

Time To Adopt Developmental Origins Of Health And Disease (Dohad) Science In Pakistan, Rozina Nuruddin, Akbar Shoukat Ali, Nuruddin Badruddin Mohammed

Community Health Sciences

No abstract provided.

Molecular Characterization Of Multidrug-Resistance In Gram-Negative Bacteria From The Peshawar Teaching Hospital, Pakistan, A. Masseron, L. Poirel, B. Jamil Ali, M. A. Syed, P. Nordmann

Section of Pulmonary & Critical Care

Extended-spectrum β-lactamases, carbapenemases, 16S rRNA methylases conferring pan-drug aminoglycoside resistance and colistin resistance were investigated among Gram-negative bacteria recovered from clinical samples (infections) from 200 individuals hospitalized at the Khyber Teaching Hospital of Peshawar, north Pakistan, from December 2017 to March 2018. Out of 65 isolates recovered, 19% were carbapenem resistant and 16% carried a bla NDM-1 gene, confirming the widespread distribution of NDM producers in this country. The association of the NDM carbapenem-resistance determinant, together with the extended-spectrum β-lactamase CTX-M-15 and 16S rRNA methylases, was frequent, explaining the multidrug-resistance pattern observed. All isolates remained susceptible to colistin.

Burden And Risk Of Neurological And Cognitive Impairment In Pediatric Sickle Cell Anemia In Uganda (Brain Safe): Final Results Of The Cross-Sectional Analysis, Nancy Green, Deogratias Munube, Paul Bangirana, Linda Buluma, Bridget Kebirungi, Robert Opoka, Ezekiel Mupere, Philip Kasirye, Sarah Kiguli, Annet Birabwa

Paediatrics and Child Health, East Africa

Background: Children with sickle cell anemia (SCA) are highly susceptible to stroke and other manifestations of pediatric cerebral vasculopathy. Detailed evaluations in sub-Saharan Africa are limited.

Methods: We aimed to establish the frequency and types of pediatric brain injury in a cross-sectional study at a large SCA clinic in Kampala, Uganda in a randomly selected sample of 265 patients with HbSS ages 1–12 years. Brain injury was defined as one or more abnormality on standardized testing: neurocognitive impairment using an age-appropriate test battery, prior stroke by examination or transcranial Doppler (TCD) velocities associated with stroke risk in children with …

Labrad : Vol 45, Issue 3 - October 2019, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Therapeutic Drug Monitoring for Antibiotics in Infections
• Biomarkers of Sepsis
• Serum Procalcitonin Level - Marker of Bacterial Infection
• Bone Marrow Findings in Malaria
• Antibiogram: A Clinicians’ Reference for Antibiotic Selection
• Laboratory Diagnosis of Meningitis
• Detection of Pneumocystis Jirovecii by PCR
• Microbiology Quiz
• Radiology Pathology Correlation- Orthopedic Pathology
• Role of Imaging in the Diagnosis and Management of Hepatic Abscess
• The Best of the Past
• Microbiology Quiz’s Answer
• Polaroid

Global Burden Of Atherosclerotic Cardiovascular Disease In People With Hepatitis C Virus Infection: A Systematic Review, Meta-Analysis, And Modelling Study, Kuan Ken Lee, Dominik Stelzle, Rong Bing, Mohamed Anwar, Fiona Strachan, Sophia Bashir, David E. Newby, Jasmit Shah, Michael Chung, Gerald S. Bloomfield

Internal Medicine, East Africa

Background: More than 70 million people worldwide are estimated to have hepatitis C virus (HCV) infection. Emerging evidence indicates an association between HCV and atherosclerotic cardiovascular disease. We aimed to determine the association between HCV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HCV.

Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, Ovid Global Health, and Web of Science databases from inception to May 9, 2018, without language restrictions, for longitudinal studies that evaluated the risk ratio (RR) of cardiovascular disease in people with HCV compared with those without …

Infections In Patients With Multiple Myeloma Treated With Conventional Chemotherapy: A Single-Center, 10-Year Experience In Pakistan, Mohammad Faizan Zahid, Natasha Ali, Myra Nasir, Maria Haider Baig, Mustafa Iftikhar, Syed Usman Bin Mahmood, Arhama Malik, Sara Atif, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Introduction: Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality.
Objective: We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period.
Method and results: Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was …

Longitudinally Extensive Transverse Myelitis With Seropositive Chikungunya, Sajid Hameed, Mubashar Memon, Hina Imtiaz, Dureshahwar Kanwar

Section of Neurology

Chikungunya viral (CHIKV) fever is often a self-limiting febrile illness associated with severe debilitating arthralgia. Neurological complications associated with CHIKV, although rare, have been reported in literature; however, longitudinally extensive transverse myelitis (LTEM) is rarely associated with it. We present a case of a middle-aged man with a 1-week history of low-grade fever and arthralgia followed by urinary retention and quadriplegia. A sensory level was noted at T2. On subsequent investigations, he was diagnosed with LETM. Although LETM is commonly seen in patients with neuromyelitis optica, the other possible etiologies are inflammatory and parainfectious. To date, only two cases of …

Three-Dimensional Visualization Software Assists Learning In Students With Diverse Spatial Intelligence In Medical Education, Zehra Jamil, Amna A. Saeed, Sarosh Madhani, Safia Baig, Zahra Cheema, Syeda Sadia Fatima

Department of Biological & Biomedical Sciences

This study evaluated effect of mental rotation (MR) training on learning outcomes and explored effectiveness of teaching via three-dimensional (3D) software among medical students with diverse spatial intelligence. Data from n = 67 student volunteers were included. A preliminary test was conducted to obtain baseline level of MR competency and was utilized to assign participants to two experimental conditions, i.e., trained group (n = 25) and untrained group (n = 42). Data on the effectiveness of training were collected to measure participants' speed and accuracy in performing various MR activities. Six weeks later, a large class format (LCF) session was …

Risk Factors For Mortality Of Patients With Ceftriaxone Resistant E. Coli Bacteremia Receiving Carbapenem Versus Beta Lactam/Beta Lactamase Inhibitor Therapy, Nosheen Nasir, Sara Ahmed, , Samrah Razi, Safia Awan, Syed Faisal Mahmood

Section of Internal Medicine

Objective: Extended spectrum β-lactamases (ESBL) producing Enterobacteriaceae predominantly E. coli and K. pneumoniae bacteremia have limited treatment options and high mortality. The objective was to determine the risk factors for in-hospital mortality particularly treatment with carbapenem versus beta lactam/beta lactamase combination (BL/BLI) in patients with ceftriaxone resistant E. coli bacteremia. A retrospective cohort study was conducted at the Aga Khan University, Karachi, Pakistan. Adult patients with sepsis and monomicrobial ceftriaxone resistant E. coli bacteremia were enrolled. Factors associated with mortality in patients were determined using logistic regression analysis.

Results: Mortality rate was 37% in those empirically treated with carbapenem …

Primary Esophageal Tuberculosis Mimicking Esophageal Carcinoma On Computed Tomography: A Case Report., Muhammad Salman Khan, Muhammad Hassan Arif, Amir Humza Shohail, Waseem Ahmed Memon

Department of Radiology

BACKGROUND:
Tuberculosis (TB) has a rare extrapulmonary manifestation known as esophageal tuberculosis, accounting for 0.2% of total TB patients. Esophageal TB typically presents with dysphagia, with retrosternal pain or odynophagia, but generalized symptoms such as low-grade fever, decreased appetite, and weight loss are also observed. Esophageal carcinoma and Crohn's disease of the esophagus are important differential diagnoses with similar presentation.
CASE SUMMARY
: We present a case of a 25-year-old male, who presented with esophageal TB mimicking an esophageal carcinoma. Lab work-up, Mantoux test, and chest X-ray were normal. Barium-swallow examination showed moderate dilatation of distal esophagus with a nodular …

Detection And Concentration Of Plasma Aflatoxin Is Associated With Detection Of Oncogenic Human Papillomavirus In Kenyan Women, Jianjun Zhang, Elkanah Omenge, Philip Tonui, Yan Tong, Titus Manai, Stephen Kiptoo, Kapten Muthoka, John Groopman, Joshua Smith, Erin Madeen

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer is common in Kenyan women. Cofactors in addition to infection with oncogenic human papillomavirus (HPV) are likely to be important in causing cervical cancer, because only a small percentage of HPV-infected women will develop this malignancy. Kenyan women are exposed to dietary aflatoxin, a potent carcinogen and immunosuppressive agent, which may be such a cofactor.

Methods: Demographics, behavioral data, plasma, and cervical swabs were collected from 88 human immunodeficiency virus-uninfected Kenyan women without cervical dysplasia. Human papillomavirus detection was compared between women with or without plasma aflatoxin B1-lysine (AFB1-lys) and evaluated in relation to AFB1-lys concentration.

Results: …

Seasonal Variation In Acute Cholecystitis: An Analysis Of Cholecystectomies Spanning Three Decades, Muhammad Shoaib Khan, Noman Shahzad, Sumaiyya Arshad, Amir Hafeez Shariff

Department of Surgery Docs

BACKGROUND:
Seasonal variation in the occurrence of medical illnesses reflects the effect of the environment, provides insight into pathogenesis, and can assist health care administrators in allocating resources accordingly. Seasonal variation has been reported in various infectious and surgical diseases, but has been rarely studied in acute cholecystitis. Our objective was to study seasonal variation in acute cholecystitis at our institution.
METHODS:
We performed a retrospective analysis of patients who underwent cholecystectomy for acute cholecystitis from January 1988 to December 2018. Chi-square goodness-of-fit test was used to analyze seasonality of acute cholecystitis adjusting for variation in number of days between …

Inspire : Vol 2, Issue 9, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From The Chair
• Women in Global Health (WGH) Pakistan Chapter
• Faculty Development Workshop Series
• Department of Medicine at National and International Forums Featured Faculty Profile Dr. Rabeea Azmat “ There is no shortcut to success!”
• What Are Academics Around the World Reading This Month?
• Publications

Morning Cortisol As An Alternative To Short Synecthan Test For The Diagnosis Of Primary Adrenal Insufficiency, Imran Ulhaq, Tauseef Ahmad, Adeel Khoja, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Objective: To determine 7-9 am serum cortisol less than 5mcg/dl is an independent reliable confirmatory test for the diagnosis of primary adrenal insufficiency (PAI).

Methods: A total of 164 patients who visited the outpatient or inpatient department of Aga Khan University Hospital from June 2011 to June 2017 were included for the study. All those patients whose levels came out less than 5mcg/dl were recruited for the study and they all underwent SST. Other demographic and laboratory data were also recorded.

Results: The sensitivity of morning cortisol for diagnosis of PAI is 100% if levels are <1mcg/dl and decreases to 71.88% if levels are up to 5mcg/dl.

Conclusion: Morning cortisol is …

Vitamin D Status And Risk Of Incident Tuberculosis Disease: A Nested Case-Control Study, Systematic Review, And Individual-Participant Data Meta-Analysis, Omowunmi Aibana, Chuan-Chin Huang, Said Aboud, Alberto Arnedo-Pena, Mercedes C. Becerra, Juan Bautista Bellido-Blasco, Ramesh Bhosale, Roger Calderon, Rabia Hussain, Najeeha Talat Iqbal

Department of Pathology and Laboratory Medicine

Background: Few studies have evaluated the association between preexisting vitamin D deficiency and incident tuberculosis (TB). We assessed the impact of baseline vitamins D levels on TB disease risk.
Methods and Findings: We assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6,751 HIV-negative household contacts of TB patients enrolled between September 1, 2009, and August 29, 2012, in Lima, Peru. We screened for TB disease at 2, 6, and 12 months after enrollment. We defined cases as household contacts who developed TB disease at least 15 days after enrollment of the index patient. …

Pathobiome Driven Gut Inflammation In Pakistani Children With Environmental Enteric Dysfunction, Najeeha Talat Iqbal, Sana Syed, Furqan Kabir, Zehra Jamil, Tauseef Akhund, Shahida Qureshi, Jie Liu, Jennie Ma Z, Shan Guleria, Andrew Gewirtz, Christopher Duggan P, Molly Hughes A, Kamran Sadiq, Asad Ali

Department of Paediatrics and Child Health

Environmental Enteric Dysfunction (EED) is an acquired small intestinal inflammatory condition underlying high rates of stunting in children <5 years of age in low- and middle-income countries. Children with EED are known to have repeated exposures to enteropathogens and environmental toxins that leads to malabsorptive syndrome. We aimed to characterize association of linear growth faltering with enteropathogen burden and subsequent changes in EED biomarkers. In a longitudinal birth cohort (n = 272), monthly anthropometric measurements (Length for Age Z score- LAZ) of asymptomatic children were obtained up to 18 months. Biological samples were collected at 6 and 9 months for the assessment of biomarkers. A customized TaqMan array card was used to target 40 enteropathogens in fecal samples. Linear regression was applied to study the effect of specific enteropathogen infection on change in linear growth (ΔLAZ). Presence of any pathogen in fecal sample correlated with serum flagellin IgA (6 mo, r = 0.19, p = 0.002), fecal Reg 1b (6 mo, r = 0.16, p = 0.01; 9mo, r = 0.16, p = 0.008) and serum Reg 1b (6 mo, r = 0.26, p<0.0001; 9 mo, r = 0.15, p = 0.008). At 6 months, presence of Campylobacter [β (SE) 7751.2 (2608.5), p = 0.003] and ETEC LT [β (SE) 7089.2 (3015.04), p = 0.019] was associated with increase in MPO. Giardia was associated with increase in Reg1b [β (SE) 72.189 (26.394), p = 0.006] and antiflic IgA[β (SE) 0.054 (0.021), p = 0.0091]. Multiple enteropathogen infections in early life negatively correlated with ΔLAZ, and simultaneous changes in gut inflammatory and permeability markers. A combination vaccine targeting enteropathogens in early life could help in the prevention of future stunting

Polio: From Eradication To Systematic, Sustained Control, Oliver Razum, Devi Sridhar, Albrecht Jahn, Shehla Zaidi, Gorik Ooms, Olaf Müller

Community Health Sciences

No abstract provided.

Leaving Against Medical Advice From In-Patients Departments Rate, Reasons And Predicting Risk Factors For Re-Visiting Hospital Retrospective Cohort From A Tertiary Care Hospital, Obada Hasan, Muhammad Adil Samad, Hamza Khan, Maryam Sarfraz, Shahryar Noordin, Tashfeen Ahmad, Gul Nowshad

Section of Orthopaedic Surgery

Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital.
Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who …

Suppressor Of Cytokine Signaling-3 In Pregnant Females With Or Without Hypertension, Huma Shoukat Ali, Mubeen Ali, Sabah Farhat, Syeda Sadia Fatima

Department of Biological & Biomedical Sciences

Suppression of Cytokine Signalling-3 (SOCS-3) modulates the inflammatory pathways responsible for vascular stability. Therefore, we aimed to estimate SOCS-3 levels in 2nd trimester pregnant females and correlate it with blood pressure. A case control study recruiting (n=111) females was conducted at the Aga Khan University. They were classified as pregnancy induced hypertensives ornormotensive as per American College of Obstetricians and Gynecologists Guidelines. Weight, Body mass index, lipid profile and blood glucose were recorded while SOCS-3 was measured by ELISA. Higher SOCS-3 levels were seen in hypertensive group (30 pg/ml) versus normotensive (16 pg/ml). Both Systolic & diastolic blood pressure (r=0.520; …

Early Life Child Micronutrient Status, Maternal Reasoning, And A Nurturing Household Environment Have Persistent Influences On Child Cognitive Development At Age 5 Years: Results From Mal-Ed, Benjamin J J. Mccormick, Stephanie A. Richard, Laura E. Caulfield, Laura L. Pendergast, Jessica C. Seidman, Beena Koshy, Reeba Roshan, Rita Shrestha, Erling Svensen, Muneera Rasheed

Department of Paediatrics and Child Health

Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown.
Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y.
Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured …

Fungal Cervical Abscess Complicated By Necrotizing Fasciitis Leading To Descending Necrotizing Mediastinitis: A Case Report., Zainab Abbasi, Hina Inam, Sajan Das, Saulat Fatimi, Sejal Neel

Section of Cardiothoracic Surgery

Cervical necrotizing fasciitis (CNF) is a rapidly spreading deep neck infection with a high mortality rate if left untreated. The occurrence of necrotizing infections in the head and neck region is uncommon; therefore, it is a rare cause of chest pain presenting to the emergency department. Here, we present an interesting case of fungal cervical skin abscess complicated by necrotizing fasciitis that progressed to involve the mediastinum, causing necrotizing mediastinitis with pneumomediastinum in an elderly female. The patient presented to the emergency department with chest pain, shortness of breath, and fever. She had a 10-day history of a mass in …

Microbial Colonization Of Pneumatic Tourniquets In The Orthopedic Operating Room, Syed Hamza Mufarrih, Nada Qaisar Qureshi, Rizwan Haroon Rashid, Bilal Ahmed, Seema Irfan, Akbar Jaleel Zubair, Shahryar Noordin

Section of Orthopaedic Surgery

Background: The rate of surgical site infections following orthopedic procedures is approximately 2% globally. Potential sources of contamination in the operating room include pneumatic tourniquets, blood pressure cuffs, and stethoscopes, among others. Our study aims to investigate microbial colonization on reusable pneumatic tourniquets stored and used in the orthopedic department of our institution and evaluate the efficacy of the cleaning protocols employed. Methods: Over a course of two weeks, 26 samples were obtained. A total of 14 pneumatic tourniquets were sampled preoperatively on Monday morning following the weekly cleaning protocol of soaking the tourniquets in sodium hypochlorite for 30 minutes …

Rosai-Dorfman's Disease, An Uncommon Cause Of Common Clinical Presentation, Om Parkash, Mian Shah Yousaf, Ghulam Fareed

Section of Gastroenterology

Sinus histiocytosis with massive lymphadenopathy also known as Rosai-Dorfman disease is a rare benign disease that typically manifests as lymphadenopathy with or without systemic manifestations whose etiology remains poorly understood. Most common clinical presentation is painless bilateral cervical lymphadenopathy. However, it also can present in various extranodal sites and can easily be missed because of its rarity if not considered in the differential diagnosis. It commonly occurs in children and young adults with a slightly male predominance. Clinically patients may be mistaken for lymphoma and other infectious disorders like tuberculosis especially in developing countries like in Pakistan where tuberculosis is …

Emergency Care Surveillance And Emergency Care Registries In Low-Income And Middle-Income Countries: Conceptual Challenges And Future Directions For Research, Hani Mowaf, Christine Ngaruiya, Gerard O'Reilly, Olive Kobusingye, Vikas Kapil, Andres Rubiano, Marcus Ong, Juan Carlos Puyana, Akm Fazlur Rahman, Rashid Jooma, Blythe Beecrof, Junaid Razzak

Section of Neurosurgery

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. …