Digital Commons Network^™

Hematological Profile And Gametocyte Carriage In Malaria Patients From Southern Pakistan, Najia Karim Ghanchi, Mohammad Hassaan Khan, Muhammad Abdullah Arain, Mustafa Bin Ali Zubairi, Ahmed Raheem Buksh, Muhammad A. Khan, Mohammad A. Beg

Department of Pathology and Laboratory Medicine

Background: Malarial infection is a major cause of concern, both worldwide and in Pakistan. Gametocytes are the sexual forms of the parasite that are essential for transmission. They fuse inside the mosquito to develop sporozoites. Gametocytes of the plasmodium parasites, which cause the infection, differentiate into male and female gametocytes. These gametocytes constitute the sexual stage of the malaria parasite and are essential in transmission of the disease from human to vector Anopheles. Gametocytes are affected by factors such as host immunity, drug treatment, reticulocytemia, anemia, low levels of asexual parasitemia and stress to the parasite. The aim of this …

Progress In Adolescent Health And Wellbeing: Tracking 12 Headline Indicators For 195 Countries And Territories, 1990–2016, Peter S. Azzopardi, Stephen J. C. Hearps, Kate L. Francis, Elissa C. Kennedy, Ali H. Mokdad, Nicholas J. Kassebaum, Stephen Lim, Caleb M. S. Irvine, Theo Vos, Alex D. Brown, Surabhi Dogra, Stuart A. Kinner, Natasha S. Kaoma, Mariam Naguib, Nicola J. Reavley, Jennifer Requejo, John S. Santelli, Susan M. Sawyer, Vegard Skirbekk, Marleen Temmerman, Jordan Tewhaiti-Smith, Joseph L. Ward, Russell M. Viner, George C. Patton

Obstetrics and Gynaecology, East Africa

Background: Rapid demographic, epidemiological, and nutritional transitons have brought a pressing need to track progress in adolescent health. Here, we present country-level estimates of 12 headline indicators from the Lancet Commission on adolescent health and wellbeing, from 1990 to 2016.

Methods: Indicators included those of health outcomes (disability-adjusted life-years [DALYs] due to communicable, maternal, and nutritional diseases; injuries; and non-communicable diseases); health risks (tobacco smoking, binge drinking, overweight, and anaemia); and social determinants of health (adolescent fertility; completion of secondary education; not in education, employment, or training [NEET]; child marriage; and demand for contraception satisfied with modern methods). We drew …

Global Monitoring Of Antimicrobial Resistance Based On Metagenomics Analyses Of Urban Sewage, Rene S. Hendriksen, Patrick Munk, Patrick Njage, Bram Van Bunnik, Luke Mcnally, Oksana Lukjancenko, Timo Röder, David Nieuwenhuijse, Rumina Hasan, Sadia Shakoor

Department of Pathology and Laboratory Medicine

Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use metagenomic analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross-selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socio-economic, …

Empowering Hiv-Infected Women In Lowresource Settings: A Pilot Study Evaluating A Patient-Centered Hiv Prevention Strategy For Reproduction In Kisumu, Kenya, Okeoma Mmeje, Betty Njoroge, Pauline Wekesa, Alfred Murage, Raphael O. Ondondo, Sheryl Van Der Poel, Mary A. Guze, Starley B. Shade, Elizabeth A. Bukusi, Deborah Cohan, Craig R. Cohen

Obstetrics and Gynaecology, East Africa

Background: Female positive/male negative HIV-serodiscordant couples express a desire for children and may engage in condomless sex to become pregnant. Current guidelines recommend antiretroviral treatment in HIV-serodiscordant couples, yet HIV RNA viral suppression may not be routinely assessed or guaranteed and pre-exposure prophylaxis may not be readily available. Therefore, options for becoming pregnant while limiting HIV transmission should be offered and accessible to HIV-affected couples desiring children.

Methods: A prospective pilot study of female positive/male negative HIV-serodiscordant couples desiring children was conducted to evaluate the acceptability, feasibility, and effectiveness of timed vaginal insemination. Eligible women were 18-34 years with regular …

Multiple Sclerosis In Pakistan And Need For Multiple Sclerosis Registry, Haris Majid Rajput, Mohammad Wasay, Mazhar Badshah, Muhammad Hassan

Pakistan Journal of Neurological Sciences (PJNS)

Multiple sclerosis(MS) is an acquired chronic demyelinating disease of central nervous system is a leading cause of non-traumatic disability in young with significant socioeconomic impact. The aim of this study was to provide a comprehensive review of all available data of MS in Pakistan.

Effectiveness Of 10-Valent Pneumococcal Conjugate Vaccine Against Vaccine-Type Invasive Pneumococcal Disease In Pakistan, Atif Riaz, Syed Mohiuddin, Sara Husain, Mohammad Tahir Yousafzai, Muhammad Sajid, Furqan Kabir, Najeeb Rehman, Waseem Mirza, Basit Salam, Naila Naila, Khatidja Pardhan, Anita K. M. Zaidi, Syed Asad Ali

Department of Paediatrics and Child Health

Objective: To assess the effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) against invasive pneumococcal disease (IPD) due to vaccine serotypes of Streptococcus pneumoniae post introduction of the vaccine into the routine immunization program in Pakistan.
Methods: A matched case-control study was conducted at 16 hospitals in Sindh Province, Pakistan. Children aged (eligible to receive PCV10) who presented with radiographically confirmed pneumonia and/or meningitis were enrolled as cases. PCR for the lytA gene was conducted on blood (for radiographic pneumonia) and cerebrospinal fluid (for meningitis) samples to detect S. pneumoniae. The proportion of IPD due to vaccine serotypes (including vaccine-related serogroups) …

Dengue Fever Presenting As Quadriparesis Due To Hypokalaemia: A Rare Presentation, Syed Muhammad Zubair, Syed Ahsan Ali, Saira Furqan

Section of Internal Medicine

Dengue is one of the leading causes of arthropod borne viral haemorrhagic fever. Majority of the times, it clinically manifests as fever, arthralgia and rash; however, we present a case of a young man who presented with progressively increasing weakness of all four limbs. Initial investigations showed low potassium, hence he was managed as hypokalaemic periodic paralysis. With initial history of fever and low platelets, dengue was suspected. Dengue antibody was checked which came out to be positive. Potassium was replaced which led to improvement in power of his limbs. He was discharged in a stable condition with a diagnosis …

Effect Of 10-Valent Pneumococcal Conjugate Vaccine On The Incidence Of Radiologically-Confirmed Pneumonia And Clinically-Defined Pneumonia In Kenyan Children: An Interrupted Time-Series Analysis, Micah Silaba, Michael Ooko, Christian Bottomley, Joyce Sande, Rachel Benamore, Kate Park, James Ignas, Kathryn Maitland, Neema Mturi, Anne Makumi

Imaging & Diagnostic Radiology, East Africa

Background: Pneumococcal conjugate vaccines (PCV) are highly protective against invasive pneumococcal disease caused by vaccine serotypes, but the burden of pneumococcal disease in low-income and middle-income countries is dominated by pneumonia, most of which is non-bacteraemic. We examined the effect of 10-valent PCV on the incidence of pneumonia in Kenya.

Methods: We linked prospective hospital surveillance for clinically-defined WHO severe or very severe pneumonia at Kilifi County Hospital, Kenya, from 2002 to 2015, to population surveillance at Kilifi Health and Demographic Surveillance System, comprising 45000 children younger than 5 years. Chest radiographs were read according to a WHO standard. A …

Early Neonatal Vitamin A Supplementation And Infant Mortality: An Individual Participant Data Meta-Analysis Of Randomised Controlled Trials, Rajiv Bahl, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Biannual vitamin A supplementation is a well-established survival tool for preschool children 6 months and older in vitamin A deficient populations but this schedule misses the opportunity to intervene on most young infant deaths. Randomised trials of neonatal vitamin A supplementation (NVAS) in the first few days of life to assess its impact on under 6-month mortality in low/middle-income countries have had varying results.
Methods: Investigators of 11 published randomised placebo-controlled NVAS trials (n=163 567 children) reanalysed their data according to an agreed plan and pooled the primary outcomes of mortality from supplementation through 6 and 12 months of …

The Salt Between The Beans: A Qualitative Study Of The Role Of Auxiliary Midwives In A Hard-To-Reach Area Of Myanmar, Kyu Kyu Than, Stanley Luchters, Khaing Nwe Tin, Thazin La, James Beeson, Alison Morgan

Population Health, East Africa

Background: Auxiliary Midwives (AMWs) are unpaid volunteer health workers assisting qualified paid midwives in maternal and child health care mainly in hard-to-reach areas of Myanmar. This paper describes the relationship between AMWs and the health system in providing maternal and child services as perceived by the community, AMWs themselves and health care providers in one remote township of Myanmar.

Method: A qualitative study was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, AMWs, community members and mothers were conducted. Ten key informant interviews were performed with national, district and township level health planners and …

The Utility Of Neutrophil Gelatinase-Associated Lipocalin (Ngal) As A Marker Of Acute Kidney Injury (Aki) In Critically Ill Patients, Shabnum Khawaja, Lena Jafri, Imran Siddiqui, Madiha Hashmi, Farooq Ghani

Department of Pathology and Laboratory Medicine

In current clinical practice, Serum Creatinine (SCr) is a commonly used marker for the diagnosis of acute kidney injury (AKI). Unfortunately, due to a delayed increase in SCr, it is unable to accurately estimate the timing of the injury. The purpose of this study was to assess the ability of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict AKI in critically ill adult patients. The study was conducted at the Section of Chemical Pathology, Department of Pathology& Laboratory Medicine in collaboration with Department of Anesthesiology, at Aga Khan University Hospital in Karachi, Pakistan. Subjects in the age groups of18 to …

Correction To: Nasopharyngeal Carriage Of Streptococcus Pneumoniae In Children Under 5 Years Of Age Before Introduction Of Pneumococcal Vaccine (Pcv10) In Urban And Rural Districts In Pakistan, Muhammad Imran Nisar, Kanwal Nayani, Tauseef Akhund, Atif Riaz, Omar Irfan, Sadia Shakoor, Sehrish Muneer, Sana Muslim, Aneeta Hotwani, Furqan Kabir, Cynthia Whitney, Lindsay Kim, Velusamy Srinivasan, Syed Asad Ali, Anita K. M. Zaidi, Fyezah Jehan

Department of Paediatrics and Child Health

No abstract provided.

When Surgeons Are Rarer Than Resources - Our Experience With Improving Access To Thoracic Surgery In An Urban Setting: A Special Report, Muhammad Bin Pervez,, Mehnaz Jabeen, Shiraz Hashmi, Saulat Fatimi

Section of Cardiothoracic Surgery

With progressive globalisation enabled by technology, there is an increased interest in finding viable solutions to the myriad health problems faced by developing countries. In countries like Pakistan, occasionally the challenge is not a dearth of material resources but rather unavailability of expertise. The current paper was planned to share a model that was successfully implemented in the urban setting of Karachi, Pakistan, from 2012 onwards which significantly improved access to thoracic surgery for underprivileged individuals. Our model focussed on a qualified thoracic surgeon reviving a defunct thoracic surgical unit thereby optimising the use of resources already available in the …

Inflammatory Arthritis And Mycobacterium Tuberculosis Infection: A Diagnostic And Management Challenge For Knee Arthroplasty In Endemic Areas, Obada Hasan, Riaz Hussain Lakhdawala, Vickash Kumar, Syed Faisal Mahmood, Shahryar Noordin

Section of Orthopaedic Surgery

Tuberculosis continues to be one of the most challenging health problems more prevalent in developing countries. Pakistan ranks 5th in tuberculosis prevalence among the high-burden countries. Prosthetic joint infection of the knee by acid fast bacilli is a rare and distressing complication, occurring in nearly 1% of primary joint arthroplasties requiring prolonged medical treatment and multiple surgeries. A recent publication extensively reviewed English literature from 1952 to 2016, and repor ted only 64 prosthetic joint infec tion with tuberculosis, of which 27 cases involved the knee. Tuberculosis is a global health problem adding to the challenges that arthroplasty surgeons face …

Field Performance And Diagnostic Accuracy Of A Low-Cost Instrument-Free Point-Of-Care Cd4 Test (Visitect Cd4) Performed By Different Health Worker Cadres Among Pregnant Women, Stanley Luchters, Karl Technau, Yasmin Mohamed, Matthew F. Chersich, Paul A. Agius, Minh D. Pham, Mary L. Garcia, James Forbes, Andrew Shepherd, Ashraf Coovadia, Suzanne M. Crowe, David A. Anderson

Population Health, East Africa

Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of 350 CD4 cells/mm3. The field performance and diagnostic accuracy of the test was assessed among HIVinfected pregnant women in South Africa. A nurse performed testing at the point-ofcare using both venous and finger-prick blood, and a counselor and laboratory staff tested venous blood in the clinic laboratory (four Visitect CD4 tests/participant). Performance was compared to the mean CD4 count from duplicate flow cytometry tests on venous blood (FACSCalibur …

Retracted: The Epidemiology Of Stroke In A Developing Country (Pakistan), M Ishaq Khan, Junaid I. Khan, Sheikh I. Ahmed, Sajjad Ali

Pakistan Journal of Neurological Sciences (PJNS)

Retraction Notice

Khan MI, Khan JI, Ahmed SI, Ali S. The epidemiology of stroke in a developing country (Pakistan).

Pak J Neurol Sci. 2018;13(3):30-44.

A reader brought to our attention that the article titled “The epidemiology of stroke in a developing country (Pakistan)”, published in Volume 13, Issue 3, of Pakistan Journal of Neurological Sciences (PJNS) was a redundant (duplicate) publication. We investigated this complaint and found out that prior to its submission to PJNS on February 11 2018, this article had already been published almost verbatim in Journal of Neurology & Stroke on January 23, 2018.

Reference of the …

Integrating Nutrition Into Health Systems: What The Evidence Advocates, Rehana Salam, Jai K. Das, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

There is considerable evidence of positive health and nutrition outcomes resulting from integrating nutrition-specific interventions into health systems; however, current knowledge on establishing and sustaining effective integration of nutrition into health systems is limited. The objective of this review is to map the existing types of integration platforms and review the evidence on integrated health and nutrition programmes' impacts on specific nutrition outcomes. A literature search was conducted, and integrated nutrition programmes were examined through the lens of the six World Health Organization (WHO) building blocks, including the demand side. Forty-five studies were included in this review, outlining the integration …

Addressing Cost And Time Barriers In Chronic Disease Management Through Telemedicine: An Exploratory Research In Select Low-And Middle-Income Countries, Saleem Sayani, Momina Muzammil, Karima Saleh, Abdul Muqeet, Fabiha Zaidi, Tehniat Shaikh

Office of the Provost

Despite evidence supporting telehealth provision in developed countries, there is limited evidence regarding its economic benefits for patients living in areas where access and cost present major barriers to health care, particularly in low- and middle-income countries (LMICs). This study explores the economic benefits of telemedicine for patients, in terms of cost and times savings, and its potential role in improving chronic disease outcomes. This retrospective cross-sectional study compared telemedicine services with hypothetical in-person consultations, with a focus on patient travel time and travel cost savings. A database containing teleconsultation visits (N = 25,182) conducted at health facilities in remote …

Patients Perspective On The Non-Urgent Use Of The Emergency Department In Kenya, Carolyne Robai Matifary

Master of Medicine in Family Medicine

Background: Globally, there is an increasing demand for emergency department (ED) care in many countries accompanied by the dire need to optimize scant resources. Sub Saharan Africa (SSA) is facing a rapid surge in the prevalence of non-communicable diseases (NCDs) compounded by an already prevailing significant problem of communicable diseases and injuries. This has led to increased demand for emergency care expertise owing to acute complications of all these conditions. The impact includes ED overcrowding, increased healthcare costs, extended waiting periods and overstretched essential services. To mitigate this, it is imperative that EDs be utilized appropriately to continue providing quality …

Pre-Operative Voriconazole In Patients Undergoing Surgery For Central Nervous System Fungal Infections: Special Report, Ghani Haider, Muhammad Shahzad Shamim, Muhammad Faheem Khan, Muhammad Ehsan Bari, Ather Enam

Section of Neurosurgery

Fungal infections of the central nervous system (CNS) are uncommon. Despite several advancements in diagnosis and treatment of these infections, the mortality rates remain high. The current retrospective study was planned to define the demographic and clinical features of patients with CNS fungal infections. Conducted at Aga Khan University Hospital, Karachi, and comprising CNS fungal infections operated between January 2000 and December 2015. The study analysed whether a short course of pre-operative anti-fungal therapy may improve outcomes in these patients. There were 47 cases confirmed on histopathology and/or microbiology. Outcome measures used were Glasgow coma score (GCS), Glasgow outcome score …

Acceptability And Adequacy Of Vaginal Self Sampling For Hpv Dna Testing In Cervical Cancer Screening Among Women Attending A Tertiary Hospital Clinics In Nairobi Kenya, Sagal Omar Salad

Master of Medicine in Anatomic Pathology

Background: Cervical cancer is a main concern of women’s health globally. In Kenya, Cervical cancer is the second most common cancer in women and the leading causes of cancer related deaths. Several screening methods exist including cytology, human papilloma virus DNA test and visual inspection with Acetic Acid or Lugol’s Iodine (VIA/VILI). The current screening rate uptake in Kenya is poor, HPV DNA self-sampling may have a role in increasing the screening uptake as many studies have shown that self-sampling for HPV DNA testing is acceptable, though some others favoured over self-sampling. This study aims to assess whether vaginal HPV …

Comparison Of Vaginal Microbiota In Women With Spontaneous Preterm Labour Versus Those With Term Labour, Edgar Gulavi

Master of Medicine in Obstetrics and Gynecology

Background: Preterm birth presents a challenge on a global scale with a disease burden that is on the rise. It is a leading cause of perinatal morbidity and mortality worldwide with approximately 15 million preterm births every year. Kenya has a 12% preterm birth rate with about 190,000 babies born preterm every year. The female lower genital tract bacterial community plays a vital role in maternal and neonatal health. An association between altered vaginal microbial composition and preterm birth has been demonstrated in previous studies. However, findings in terms of composition and diversity of these bacteria across the few studies …

Eligibility And Patient Barriers To Peritoneal Dialysis In Patients With Advanced Chronic Kidney Disease, Saleem Mohamed Abdulkarim

Master of Medicine in Internal Medicine

Introduction: The burden of chronic kidney disease is on the rise in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require renal replacement therapy in the form of hemodialysis or peritoneal dialysis. The predominant modality utilized in Kenya is currently hemodialysis despite peritoneal dialysis having similar survival outcomes with the potential benefit of cost-effectiveness. There is need therefore to explore why peritoneal dialysis remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of peritoneal dialysis. Purpose: The main objective of this study is to …

Randomized Controlled Trial Of Influenza Vaccine In Patients With Heart Failure To Reduce Adverse Vascular Events (Ivve): Rationale And Design, Mark Loeb, Hisham Dokainish, Antonio Dans, Lia M. Palileo-Villanueva, Ambuj Roy, Ambuj Roy, Kamilu Karaye, Jun Zhu, Yan Liang, Gerald Yonga

Internal Medicine, East Africa

Background: Influenza is associated with an increase in the risk of cardiac and other vascular events. Observational data and small randomized trials suggest that influenza vaccination may reduce such adverse vascular events.

Research Design and Methods: In a randomized controlled trial patients with heart failure are randomized to receive either inactivated influenza vaccine or placebo annually for 3 years. Patients aged ≥18 years with a clinical diagnosis of heart failure and NYHA functional class II, III and IV are eligible. Five thousand patients from 10 countries where influenza vaccination is not common (Asia, the Middle East, and Africa) have been …

Reviewers' Responses To Medical Research Articles, Saba Sohail, Jamshed Akhtar

Department of Radiology

Objective: To document the reviewers' responses in terms of reviewers' demographic and professional characteristics, promptness of reply, and duration of reply to the request to review medical research articles for a general biomedical research journal.
Study design: Cross-sectional, observational study.
Place and duration of study: Department of Publications, College of Physicians and Surgeons Pakistan (CPSP), from October to December 2015.
Methodology: Peer reviewed articles edited by a single staff editor were included. Editorials and correspondence were excluded. Manuscript category, discipline, and the total number of reviewers per manuscript were noted. Responses were divided into no response, regrets, and responded, i.e. …

Patients’ Experiences On Accessing Health Care Services For Management Of Hypertension In Rural Bangladesh, Pakistan And Sri Lanka: A Qualitative Study, Helena Legido Quigley, Aliya Naheed, H. Asita De Silva, Imtiaz Jehan, Z Samad

Department of Medicine

Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertensiondisproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. …

Socio-Anthropological Methods To Study The Feasibility And Acceptability Of The Minimally Invasive Autopsy From The Perspective Of Local Communities: Lessons Learnt From A Large Multi-Centre Study, Maria Maixenchs, Rui Anselmo, Guillermo Martínez Pérez, Kelvin Oruko, Selidji Todagbe Agnandji, Pamela Catherine Angoissa Minsoko, Kounandji Diarra, Mahamane Djiteye, Zulfiqar Ahmed Bhutta, Shujaat Zaidi

Department of Paediatrics and Child Health

The minimally invasive autopsy (MIA), an innovative approach for obtaining post-mortem samples of key organs, is increasingly being recognized as a robust methodology for cause of death (CoD) investigation, albeit so far limited to pilot studies and research projects. A better understanding of the real causes of death in middle- and low-income countries, where underlying causes of death are seldom determined, would allow improved health planning, more targeted prioritization of available resources and the implementation of coherent public health policies. This paper discusses lessons learnt from the implementation of a Feasibility and Acceptability (F&A) study evaluating the MIA approach in …

Fly Control To Prevent Diarrhoea In Children, Jai K. Das, Yousaf Bashir Hadi, Rehana Salam, Mehar Hoda, Zohra S. Lassi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background:
Diarrhoeal disease accounts for millions of child deaths every year. Although the role of flies as vectors of infectious diarrhoea has been established, fly control is not often mentioned as an approach to decrease childhood diarrhoea. Theoretically, fly control for decreasing diarrhoea incidence can be achieved by intervening at four different levels: reduction or elimination of fly breeding sites; reduction of sources that attract houseflies; prevention of contact between flies and disease-causing organisms; and protection of people, food, and food utensils from contact with flies.
Objectives:
To assess the impact of various housefly control measures on the incidence of …

Business Not As Usual: How Multisectoral Collaboration Can Promote Transformative Change For Health And Sustainable Development, Shyama Kuruvilla, Rachael Hinton, Ties Boerma, Ryan Bunney, Nuria Casamitjana, Rafael Cortez, Patrizia Fracassi, Jennifer Franz-Vasdeki, Daniel Helldén, Joanne Mcmanus, Jai K. Das

Department of Paediatrics and Child Health

No abstract provided.

Pharmacy Newsletter : December 2018, Pharmacy Department

Department of Pharmacy Archives

Content:

• Seizure Prophylaxis in Adult Traumatic Brain Injury
• Tizanidine and Ciprofloxacin – Serious Drug Interaction
• Seasonal Flu and Influenza Vaccine in Healthcare Workers
• Raised Concerns on Quinolones for Hypoglycemia and Psychiatric Adverse Effect
• Rabies Immunization: Recommendations WHO 2018