Digital Commons Network^™

Health In Surroundings: Application Of The Theory Of Environment In Nursing Practice, Nasreen Rafiq

School of Nursing & Midwifery

Nursing practices are guided by theoretical frameworks which provide functional basis to nursing care. This paper discusses the application of Nightingale’s theory of environment in nursing practices. The theory highlights and explains 13 environmental cannons which include ventilation, cleanliness of walls/rooms, light, noise, personal cleanliness, bed and bedding, and taking food. Florence exquisitely explains the influence of environmental health on patients wellbeing. The application of the theory in nursing practices will help to understand and reflect the direct relation of environment on patients health.

Bone Graft Donor Site Infection With A Rare Organism, Aeromonas Hydrophila: A Typical Location, Presentation And Organism With 2 Years Follow-Up: Case Report, Obada Hasan, Wajiha Khan, Muneeba Jessar, Aly Zaheer Pathan, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

Introduction: Aeromonas are Gram-negative bacilli often causing necrotizing fasciitis or sepsis in immunocompromised patients. Aeromonas Hydrophila is most often found in immunocompromised patients or those with burns or aquatic trauma. When patients present with a discharge and infection on bone graft donor site and progressive sepsis, an Aeromonas hydrophila infection should be considered in the differential diagnosis.
Presentation of Case: We report here a rare case of Aeromonas hydrophila with surgical site sep- sis/infection in an immunocompromised 69 years old female, with several comorbids. Here we are reporting infection on donor surgical graft site, sparing major surgical site with the …

Global Trends In Typhoidal Salmonellosis: A Systematic Review, Daina Als, Amruta Radhakrishnan, Paul Arora, Michelle F. Gaffey, Susan Campisi, Russanthy Velummailum, Farhana Zareef, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Typhoid and paratyphoid fever continue to significantly contribute to global morbidity and mortality. Disease burden is higher in low-and middle-income settings where surveillance programs are rare and little systematic information exists at population level. This review evaluates national, regional, and global trends in the incidence of typhoid fever and of related morbidity and mortality. A literature search in Medline, Embase, and Web of Science was conducted in June 2016, followed by screening and data extraction in duplicate. Studies reporting blood culture estimates of typhoid or paratyphoid morbidity and mortality were included in the analysis. Five thousand five hundred sixty-three unique …

Causes And Incidence Of Community-Acquired Serious Infections Among Young Children In South Asia (Anisa): An Observational Cohort Study., Samir K. Saha, Stephanie J. Schrag, Anita K. M. Zaidi, Zulfiqar Ahmed Bhutta, Sajid Bashir Soofi, Muhammad Imran Nisar, Benazir Baloch, Furqan Kabir, Sheraz Ahmed, Imran Ahmed

Department of Paediatrics and Child Health

Background: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia.
Methods: From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate …

Evidence Of Chikungunya Virus Disease In Pakistan Since 2015 With Patients Demonstrating Involvement Of The Central Nervous System, Kelli L. Barr, Erum Khan, Joveria Farooqi, Kehkashan Imtiaz, Dhani Prakoso, Faisal Malik, John A. Lednicky, Maureen T. Long

Department of Pathology and Laboratory Medicine

Several arboviruses are endemic to and co-circulate in Pakistan. In recent years, Pakistan has observed a rise in arboviral infections. A cross-sectional study for arboviral diseases, which included screening for Chikungunya virus (CHIKV), was initiated in 2015 to determine which pathogens were causing disease in patients presenting to health care services. Exposure to CHIKV was verified via detection of viral nucleic acids or virus-specific IgM with virus-specific neutralizing antibodies. Out of 997 enrolled patients presenting with clinical features suggestive of arboviral disease, 102 patients were positive for CHIKV IgM antibodies and 60 patients were positive for CHIKV nucleic acids or …

Cancer Prevalence In Pakistan: Meta-Analysis Of Various Published Studies To Determine Variation In Cancer Figures Resulting From Marked Population Heterogeneity In Different Parts Of The Country, Romana Idress, Saira Fatima, Jamshid Abdul Ghafar, Ahmed Raheem, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Background: Pakistan’s population is ethnically diverse with distinct ethnic groups inhabiting various parts of the country. Cancer statistics obtained from specific regions populated by distinct ethnic groups may vary considerably. There is no national cancer registry. To determine whether there are indeed significant statistical differences in cancer incidence and prevalence, data was recorded from different parts of Pakistan based on the ethnic composition of the population in those parts.
Methods: Ten papers (original articles) on cancer incidence and prevalence in Pakistan published in the last two decades were selected from PubMed and Google Scholar. Meta-analysis of findings of these studies …

Synovial Sarcoma Of Cervicodorsal Spine: A Case Report, Wali Umer Shah, Syeda Dania Shujaat, Naseeb Ullah, Salman Mansoor

Section of Neurology

Synovial sarcoma is a soft-tissue sarcoma. Its involvement of the spine is extremely rare. We report a 40 year old male who presented with shoulder pain and progressive weakness in all four limbs for six months with a visible, slowly growing bulge in his upper back. On examination he had quadriparesis and diffuse sensory deficit. MRI of the cervical spine showed a large soft tissue mass, iso to hypointense, extending into the neural canal, compressing the cord. The mass had a few internal areas of contrast enhancement with extension into the right paraspinal regions involving the vertebral bodies. Sub-periosteal spine …

Slaying Little Dragons: The Impact Of The Guinea Worm Eradication Program On Dracunculiasis Disability Averted From 1990 To 2016, Elizabeth A. Cromwell, Sharon Roy, Dieudonne P. Sankara, Adam Weiss, Jeffrey Stanaway, Ellen Goldberg, David M. Pigott, Heidi Larson, Stein Emil Vollset, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: The objective of this study was to document the worldwide decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD.
Methods: The incidence of GWD was modeled for each endemic country using annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate …

Inherited Bleeding Disorders-Experience Of A Not-For-Profit Organization In Pakistan, Shabneez Hussain, Shahida Baloch, Azra Parvin, Akbar Najmuddin, Farhana Musheer, Mubashra Junaid, Rab Nawaz Memon, Fareeda Bhanbhro, Hayat Ullah, Bushra Moiz

Department of Pathology and Laboratory Medicine

Patient registry is a powerful tool for planning health care and setting groundwork for research. This survey reports a detailed registry of inherited bleeding disorders (IBD) and their management at a not-for-profit organization in a developing country to form the basis for planning development and research. We reviewed medical records of patients with IBD from 8 hemophilia treatment centers of Fatimid Foundation located in various cities. Information collected included sociodemographic data, diagnostic tests, severity of hemophilia A and B, number of bleeding episodes per year, site and frequency of hemarthrosis, and seropositivity for viral diseases. We analyzed 1497 patients from …

Evaluation Of Breast Cancer Biomarkers Using Genexpert® On Core Biopsy-A Retrospective Laboratory Based Validation Study., Erick Chesori

Master of Medicine in Anatomic Pathology

Introduction: Breast cancer is the most common malignancy in women worldwide. It is a significant cause of cancer related morbidity and mortality among Kenyan women. Evaluation of Estrogen receptor (ER), Progesterone receptor (PR), and Human epidermal growth factor receptor 2 (HER2) in breast cancer tissue is standard of care as these biomarkers have been shown to have both prognostic and predictive utility. Immunohistochemistry (IHC) is the gold standard for evaluation of ER/PR/HER2, but its availability in Kenya is limited due to the high operational cost. There have been recent developments in alternative cheaper and readily accessible molecular based testing platforms …

Resistome Of Carbapenem- And Colistin-Resistant Klebsiella Pneumoniae Clinical Isolates, Sara Lomonaco, Matthew A. Crawford, Christine Lascols, Ruth E. Timme, Kevin Anderson, David R. Hodge, Debra J. Fisher, Segaran P. Pillai, Stephen A. Morse, Erum Khan

Department of Pathology and Laboratory Medicine

The emergence and dissemination of carbapenemases, bacterial enzymes able to inactivate most β-lactam antibiotics, in Enterobacteriaceae is of increasing concern. The concurrent spread of resistance against colistin, an antibiotic of last resort, further compounds this challenge further. Whole-genome sequencing (WGS) can play a significant role in the rapid and accurate detection/characterization of existing and emergent resistance determinants, an essential aspect of public health surveillance and response activities to combat the spread of antimicrobial resistant bacteria. In the current study, WGS data was used to characterize the genomic content of antimicrobial resistance genes, including those encoding carbapenemases, in 10 multidrug-resistant Klebsiella …

Complete Blood Count Reference Intervals From A Healthy Adult Urban Population In Kenya, Geoffrey Omuse, Daniel Maina, Jane Mwangi, Caroline Wambua, Kiran Radia, Alice Kanyua, Elizabeth Kagotho, Mariza Hoffman, Peter Ojwang, Zul Premji, Kiyoshi Ichihara, Rajiv Erasmus

Pathology, East Africa

Background: There are racial, ethnic and geographical differences in complete blood count (CBC) reference intervals (RIs) and therefore it is necessary to establish RIs that are population specific. Several studies have been carried out in Africa to derive CBC RIs but many were not conducted with the rigor recommended for RI studies hence limiting the adoption and generalizability of the results.

Method: By use of a Beckman Coulter ACT 5 DIFF CP analyser, we measured CBC parameters in samples collected from 528 healthy black African volunteers in a largely urban population. The latent abnormal values exclusion (LAVE) method was used …

Prevalence And Factors Associated With Female Sexual Dysfunction Amongst Women Using Hormonal And Non-Hormonal Contraception At The Aga Khan University Hospital Nairobi Clinics, Momin Butt

Master of Medicine in Family Medicine

Background: Female sexual function is a complex phenomenon. It integrates all the body systems and is influenced by a variety of factors. Contraceptives have been shown to have variable effects on female sexual function, but there have not been adequately powered studies on this in our setting. Justification: The prevalence of female sexual dysfunction (FSD) has been shown to vary among different population subsets globally. The associations of different factors with FSD have also shown variable conclusions that are not generalizable to our setting. In Kenya there is a high discontinuation rate of contraception and this is mainly attributed to …

Inspire : Vol 1, Issue 3, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Tribute to Dr. Saeed Hamid
• Global Congestive Heart Failure (G-CHF)Study
• HIBA; New addition to Dr. Bilal's Family
• Dr. Muhammad Irfan elected National Delegate of European Respiratory Society (ERS) for Pakistan for next 3 years (2018-2021) and presented 3 papers
• Celebrating Dept. of Medicine at National and International Forums
• Dr. Zainab Samad,Dr. Javid Khan, Dr.Yawer Saeed and Dr.Saulat Fatima celebrating Heart Health Event IN Partnership with the Karachi Press Club
• Dr. Om Prakash Invited speaker to 1stNepal association of liver disease meeting and 6th South Asia association for liver disease

Genetic Sequencing For Surveillance Of Drug Resistance In Tuberculosis In Highly Endemic Countries: A Multi-Country Population-Based Surveillance Study, Matteo Zignol Md, Andrea Maurizio Cabibbe, Anna S. Dean, Philippe Glaziou, Natavan Alikhanova, Cecilia Ama, Sönke Andres, Anna Barbova, Rumina Hasan, Zahra Hasan

Department of Pathology and Laboratory Medicine

Background: In many countries, regular monitoring of the emergence of resistance to anti-tuberculosis drugs is hampered by the limitations of phenotypic testing for drug susceptibility. We therefore evaluated the use of genetic sequencing for surveillance of drugresistance in tuberculosis.
Methods: Population-level surveys were done in hospitals and clinics in seven countries (Azerbaijan, Bangladesh, Belarus, Pakistan, Philippines, South Africa, and Ukraine) to evaluate the use of genetic sequencing to estimate the resistance of Mycobacterium tuberculosisisolates to rifampicin, isoniazid, ofloxacin, moxifloxacin, pyrazinamide, kanamycin, amikacin, and capreomycin. For each drug, we assessed the accuracy of genetic sequencing by a comparison of the adjusted …

Environmental Enteropathy In Undernourished Pakistani Children: Clinical And Histomorphometric Analyses, Sana Syed, Sunil Yeruva, Jeremy Herrmann, Anne Sailer, Kamran Sadiq, Najeeha Talat Iqbal, Furqan Kabir, Kumail Ahmed, Shahida Qureshi, Syed Asad Ali

Department of Paediatrics and Child Health

Despite nutrition interventions, stunting thought to be secondary to underlying environmental enteropathy (EE) remains pervasive among infants residing in resource-poor countries and remains poorly characterized. From a birth cohort of 380 children, 65 malnourished infants received 12 weeks of nutritional supplementation with ready-to-use therapeutic food (RUTF). Eleven children with insufficient response to RUTF underwent upper endoscopy with duodenal biopsies, which were compared with U.S., age-matched specimens for healthy, celiac disease, non-celiac villous atrophy, non-celiac intraepithelial lymphocytosis, and graft-versus-host disease patients. Of the 11 children biopsied, EE was found in 10 (91%) with one subject with celiac disease. Morphometry demonstrated decreased …

Feasibility And Effect Of Life Skills Building Education And Multiple Micronutrient Supplements Versus The Standard Of Care On Anemia Among Non-Pregnant Adolescent And Young Pakistani Women (15-24 Years): A Prospective, Population-Based Cluster-Randomized Trial, Jo-Anna B. Baxter, Yaqub Wasan, Sajid Bashir Soofi, Zamir Suhag, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Adolescence is a critical period for physical and psychological growth and development, and vitamin and mineral requirements are correspondingly increased. Health and health behaviours correspond strongly from adolescence to adulthood. Developing a preconception care package for adolescent and young women in resource-limited settings could serve to empower them to make informed decisions about their nutrition, health, and well-being, as well as function as a platform for the delivery of basic nutrition-related interventions to address undernutrition.
Methods: In this population-based two-arm, cluster-randomized, controlled trial of life skills building education (provided bi-monthly) and multiple micronutrient supplementation (provided twice-weekly; UNIMMAP composition), we …

Long-Term Outcomes And Factors Associated With Mortality Among Patients With Moderate To Severe Pulmonary Hypertension In Kenya, Abdulaziz Mansur Abeid

Master of Medicine in Internal Medicine

Background: Pulmonary hypertension (PH) is a condition that carries significant morbidity and mortality. Studies done in sub-Saharan Africa have reported poor short-term outcomes. However, data on long-term outcomes and prognostic factors are lacking. Objectives: This study sought to determine the one and two-year survival rates and prognostic factors associated with mortality in patients with moderate to severe PH. Methods: A retrospective review of moderate to severe PH patients [pulmonary artery systolic pressure (PASP), ≥45 mmHg] diagnosed at Aga Khan University Hospital, Nairobi from 2014 to 2017 was carried out. Demographic, clinical and in hospital outcome data were extracted from medical …

A Randomized Control Trial Of English-Speaking Advanced Cancer Patients At Akus Medical And Surgical Clinics And The Impact On Qol Of One Session Of Dignity Therapy, Miriam Gatehi-Muriithi

Master of Medicine in Internal Medicine

Background: Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005. Methods: This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. Data collected was presented as Legacy documents to group 1 participants. Post intervention ESAS scores were obtained in both groups after 6 weeks. …

Comparison Of Xpert Mtb/Rif With Histology For The Detection Of Mycobacterium Tuberculosis In Formalin Fixed Paraffin Embedded Tissues At Aga Khan University Hospital, Nairobi, Njau Allan Njoroge

Master of Medicine in Anatomic Pathology

Background: Diagnosis of extrapulmonary tuberculosis (EPTB) continues to be a challenge due to the complexity of the causative organism and the wide array of pathologic features seen in this infection. A number of studies have shown polymerase chain reaction (PCR) for EPTB to be a feasible, sensitive and specific test for diagnosis of tuberculosis (TB) of which, the World Health Organisation (WHO) has given recommendations. As pertains EPTB, Xpert MTB/RIF may be used in place of conventional tests such as microscopy, histopathology and culture in lymph nodes and other tissues from patients suspected to have EPTB. It has been demonstrated …

Evaluating The Effectiveness Of Text Messaging And Phone Call Reminders To Minimize No Show At Pediatric Outpatient Clinics In Pakistan: Protocol For A Mixed-Methods Study, Sana Saeed, Noureen Somani, Fatima Sharif, Abdul Momin Kazi

Department of Paediatrics and Child Health

Background: Missing health care appointments without canceling in advance results in a no show, a vacant appointment slot that cannot be offered to others. No show can be reduced by reminding patients about their appointment in advance. In this regard, mobile health (mHealth) strategy is to use text messaging (short message service, SMS), which is available on all cellular phones, including cheap low-end handsets. Nonattendance for appointments in health care results in wasted resources and disturbs the planned work schedules.
Objectives: The purpose of this study is to evaluate the efficacy of the current text messaging (SMS) and call-based …

Geospatial Inequalities And Determinants Of Nutritional Status Among Women And Children In Afghanistan: An Observational Study, Nadia Akseer, Zaid Ahmad Bhatti, Taufiq Mashal, Sajid Bashir Soofi, Rahim Moineddin, Robert E Black Md, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Undernutrition is a pervasive condition in Afghanistan, and prevalence is among the highest in the world. We aimed to comprehensively assess district-level geographical disparities and determinants of nutritional status (stunting, wasting, or underweight) among women and children in Afghanistan.
Methods: The study used individualised data from the recent Afghanistan National Nutrition Survey 2013. Outcome variables were based on growth and weight anthropometry data, which we analysed linearly as Z scores and as dichotomous categories. We analysed data from a total of almost 14 000 index mother–child pairs using Bayesian spatial and generalised least squares regression models accounting for the …

Pharmacy Newsletter : April 2018, Pharmacy Department

Department of Pharmacy Archives

Content:

• New Guidelines of Clostridium Difficile Infection (CDI
• Botulinum Toxin Type –A: An Option to Treat Carpal Tunnel Syndrome (CTS)
• Adverse Drug Reactions (ADR) Reporting Trend at AKUH – Year 2017
• Medication Reconciliation: Step to Enter Patient Home Medication Entry

Addressing Multiple Modifiable Risks Through Structured Community-Based Learning Clubs To Improve Maternal And Infant Health And Infant Development In Rural Vietnam: Protocol For A Parallel Group Cluster Randomised Controlled Trial, Jane Fisher, Tuan Tran, Stanley Luchters, Thach D. Tran, David B. Hipgrave, Sarah Hanieh, Ha Tran, Julie Simpson, Trang Nguyen, Minh Le, Beverley-Ann Biggs

Population Health, East Africa

Introduction: Optimal early childhood development is an international priority. Risks during pregnancy and early childhood have lasting effects because growth is rapid. We will test whether a complex intervention addressing multiple modifiable risks: maternal nutrition, mental health, parenting capabilities, infant health and development and gender-based violence, is effective in reducing deficient cognitive development among children aged two in rural Vietnam.

Methods and analysis: The Learning Clubs intervention is a structured programme combining perinatal stage-specific information, learning activities and social support. It comprises 20 modules, in 19 accessible, facilitated groups for women at a community centre and one home visit. Evidence-informed …

Curbing The Hepatitis C Virus Epidemic In Pakistan: The Impact Of Scaling Up Treatment And Prevention For Achieving Elimination, Aaron G. Lim, Huma Qureshi, Hassan Mahmood, Saeed Hamid, Charlotte F. Davies, Adam Trickey, Nancy Glass, Quaid Saeed, Hannah Fraser, Josephine G. Walker,

Department of Medicine

Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve the WHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide.
Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV …

Human Papilloma Virus Correlates Of High Grade Cervical Dysplasia In Hiv-Infected Women In Mombasa, Kenya: A Cross-Sectional Analysis, Sonia Menon, Stanley Luchters, Rodolfo Rossi, Steven Callens, Mandaliya Kishor, Johannes Bogers, Davy Vanden Broeck

Population Health, East Africa

Background: Women living with HIV are at increased risk to be co-infected with HPV, persistent high-risk (HR) human papillomavirus (HPV) infection and increased HR HPV viral load, which make them more at risk for cervical cancer. Despite their inherent vulnerability, there is a scarcity of data on potential high risk (pHR) and HR HPV genotypes in HIV- infected women with cervical dysplasia and HPV-type specific viral load in this population in Sub Saharan Africa. The aim of this analysis of HIV-infected women was to explore the virological correlates of high-grade cervical dysplasia (CIN 2+) in HIV-infected women, thereby profiling HPV …

Evaluation Of Vaccine Derived Poliovirus Type 2 Outbreak Response Options: A Randomized Controlled Trial, Karachi, Pakistan, Ali Faisal Saleem Dr, Mohammad Tahir Yousafzai, Ondrej Mach, Asia Khan, Farheen Quadri, William C. Weldon, M. Steven Oberste, Syed S. Zaidi, Muhammad M. Alam, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: Outbreaks of circulating vaccine derived polioviruses type 2 (cVDPV2) remain a risk to poliovirus eradication in an era without live poliovirus vaccine containing type 2 in routine immunization. We evaluated existing outbreak response strategies recommended by the World Health Organization (WHO) for control of cVDPV2 outbreaks.
Methods: Seronegative children for poliovirus type 2 (PV2) at 22 weeks of life were assigned to one of four study groups and received respectively (1) one dose of trivalent oral poliovirus vaccine (tOPV); (2) monovalent OPV 2 (mOPV2); (3) tOPV together with a dose of inactivated poliovirus vaccine (IPV); or (4) mOPV2 with …

Effect Of Mobile Phone Text Message Reminders On Routine Immunization Uptake In Pakistan: Randomized Controlled Trial, Abdul Momin Kazi, Murtaza Ali, Khurram Zubair, Hussain Kalimuddin, Abdul Nafey Kazi, Saleem Perwaiz Iqbal, Jean-Paul Collet, Syed Asad Ali

Department of Paediatrics and Child Health

Background: Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide.
Objective: The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan.
Methods: This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had …

Serum Anti-Flagellin And Anti-Lipopolysaccharide Immunoglobulins As Predictors Of Linear Growth Faltering In Pakistani Infants At Risk For Environmental Enteric Dysfunction, Sana Syed, Najeeha Talat Iqbal, Kamran Sadiq, Jennie Z. Ma, Tauseef Akhund, Shahida Qureshi, Kerri Gosselin, Andrew Gewirtz, Christopher P. Duggan, Syed Asad Ali

Department of Paediatrics and Child Health

Background: Environmental Enteric Dysfunction (EED) in children from low-income countries has been linked to linear growth declines. There is a critical need to identify sensitive and early EED biomarkers.
Objective: Determine whether levels of antibodies against bacterial components flagellin (flic) and lipopolysaccharide (LPS) predict poor growth.
Design/Methods: In a prospective birth cohort of 380 children in rural Pakistan blood and stool samples were obtained at ages 6 and 9 months. Linear mixed effects models were used to examine longitudinal associations between quartiles of anti-flic and anti-LPS antibodies and changes in LAZ, WAZ and WLZ scores. Spearman's correlations were measured between …

Rotavirus Vaccine Response Correlates With The Infant Gut Microbiota Composition In Pakistan, Vanessa Harris, Syed Asad Ali, Susana Fuentes, Abdul Momin Kazi, Jacqueline Tate, Umesh Parashar, W. Joost Wiersinga, Carlo Giaquinto, Carolina De Weerth, Willem M. De Vos

Department of Paediatrics and Child Health

Rotavirus (RV) is the leading cause of diarrhea-related death in children worldwide and ninety-five percent of rotavirus deaths occur in Africa and Asia. Rotavirus vaccines (RVV) can dramatically reduce RV deaths, but have low efficacy in low-income settings where they are most needed. The intestinal microbiome may contribute to this decreased RVV efficacy. This pilot study hypothesizes that infants' intestinal microbiota composition correlates with RVV immune responses and that RVV responders have different gut microbiota as compared to non-responders. We conducted a nested, matched case-control study comparing the pre-vaccination intestinal microbiota composition between 10 6-week old Pakistani RVV-responders, 10 6-week …