Medicine and Health Sciences Commons^™

Does Depressed Persons With Non-Cardiovascular Morbidity Have A Higher Risk Of Cvd? A Population-Based Cohort Study In Sweden, Aysha Almas, Jette Moller, Romaina Iqbal, Andreas Lundin, Yvonne Forsel

Section of Internal Medicine

Background: Depression often co-exists with non-cardiovascular morbid conditions. Whether this comorbidity increases the risk of cardiovascular disease has so far not been studied. Thus, the aim of this study was to determine if non-cardiovascular morbidity modifies the effect of depression on future risk of CVD.
Methods: Data was derived from the PART study (acronym in Swedish for: Psykisk hälsa, Arbete och RelaTioner: Mental Health, Work and Relationships), a longitudinal cohort study on mental health, work and relations, including 10,443 adults (aged 20-64 years). Depression was assessed using the Major Depression Inventory (MDI) and self-reported data on non-cardiovascular morbidity was assessed …

Fostering Productive Conversations In A Kenyan Tertiary Intensive Care Unit: Lessons Learnt, Sayed Karar, Jamila Nambafu, Feroza Daroowalla

Internal Medicine, East Africa

Effective communication remains key in delivery of comprehensive care to patient especially in the intensive care unit (ICU) setting. However, many providers, for various reasons, struggle with the art of effective communication adversely affecting relationship with patients and their families. Little is known or has been published about effective communication in ICUs within sub-Saharan Africa.

A Study To Assess The Relationship Between Attention Deficit Hyperactivity Disorder And Obstructive Sleep Apnea In Adults, Sean Hesselbacher, Akshar A. Aiyer, Salim R. Surani, Alishah A. Suleman, Joseph Varon

Internal Medicine, East Africa

The association between obstructive sleep apnea (OSA) and attention deficit hyperactivity disorder (ADHD) is well-established in children. However, there is a paucity of literature regarding this association in adults. The aim of this study was to determine if ADHD is more common in adult patients with OSA. All patients referred to a sleep center for sleep evaluation were administered the Adult ADHD Self-Report Scale and diagnostic polysomnogram. The ADHD screen is considered positive if 4 of 6 questions in part A of the screening questionnaire were answered abnormally. The study population consisted of 194 participants, predominantly male (62%), Caucasian (54%), …

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 …

Bayesmetab: Treatment Of Missing Values In Metabolomic Studies Using A Bayesian Modeling Approach, Jasmit Shah, Guy N. Brock, Jeremy Gaskins

Internal Medicine, East Africa

Background: With the rise of metabolomics, the development of methods to address analytical challenges in the analysis of metabolomics data is of great importance. Missing values (MVs) are pervasive, yet the treatment of MVs can have a substantial impact on downstream statistical analyses. The MVs problem in metabolomics is quite challenging and can arise because the metabolite is not biologically present in the sample, or is present in the sample but at a concentration below the lower limit of detection (LOD), or is present in the sample but undetected due to technical issues related to sample pre-processing steps. The …

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 …

Correction To: Severity Of Depression, Anxious Distress And The Risk Of Type 2 Diabetes - A Population-Based Cohort Study In Sweden, Anna Deleskog, Rickard Ljung, Yvonne Forsell, Alicia Nevriana, Aysha Almas, Jette Möller

Section of Internal Medicine

Abstract

It was highlighted that the original article [1] contained an error in the flow chart in Fig. 1.

Frequency Of Peri-Operative Hypertension In A Tertiary Care Hospital In Karachi, Pakistan, Momena Sohail, Aysha Almas, Ayesha Majeed Memon, Bushra Usmani, Aamir Hameed, G. Afshan

Section of Internal Medicine

This study aims to determine the frequency of perioperative hypertension and its types (pre, intra and post-operative) hypertension in patients admitted for surgical procedures. This was a cross-sectional study conducted between the years 2012-2013 at the Aga Khan University Hospital, Karachi. Patients admitted for any surgical procedure during this time were included. Perioperative hypertension has been defined as systolic blood pressure of >140 mm Hg or a diastolic blood pressure of >90 mm Hg or whose blood pressure increased by 20% during surgery. A total of 428 surgical procedures were reviewed for the study. Overall perioperative hypertension was present in …

Acinetobacter Infections: A Retrospective Study To Determine In Hospital Mortality Rate And Clinical Factors Associated With Mortality, Rajiv Patel, Jasmit Shah, Gunturu Revathi, Wangari Siika, Reena Shah

Internal Medicine, East Africa

A retrospective case series of acinetobacter infections at a tertiary hospital in Nairobi was conducted to determine the mortality rate and factors associated with mortality. Over an eight-year period, 80 clinically significant infections were identified. The majority of infections were ventilator-associated pneumonia (40%) and bloodstream infections (30%). Eighty-six percent of the isolates were multi-drug resistant. The mortality rate in the study cohort was 45%. Twelve patients grew Acinetobacter spp. within 48 h of hospitalization, and three of these patients had no prior healthcare contact. The mean Sequential Organ Failure Assessment score was associated with mortality from acinetobacter infections.

Extension For Community Healthcare Outcomes-Palliative Care In Africa Program: Improving Access To Quality Palliative Care, Sriram Yennurajalingam, Charles E. Amos, John Weru, Edwina Beryl, Addo Opare-Lokko, Joseph Anthony Arthur, Kristy Nguyen, Olaitan Soyannwo, Runcie C.W. Chidebe, Janet L. Williams, Zhanni Lu, Ellen Baker, Sanjeev Arora, Eduardo Bruera, Suresh Reddy

Internal Medicine, East Africa

Purpose: There is limited access to quality palliative care (PC) for patients with advanced cancer in sub-Saharan Africa. Our aim was to describe the development of the Project Extension for Community Healthcare Outcomes- Palliative Care in Africa (ECHO-PACA) program and describe a preliminary evaluation of attitudes and knowledge of participants regarding the ability of the program to deliver quality PC.

Methods: An interdisciplinary team at the MD Anderson Cancer Center, guided by experts in PC in sub-Saharan Africa, adapted a standardized curriculum based on PC needs in the region. Participants were then recruited, and monthly telementoring sessions were held for …

Recognition Of Antibiotic Resistance In Spontaneous Bacterial Peritonitis Caused By Escherichia Coli In Liver Cirrhotic Patients In Civil Hospital Karachi, Pooja D. Kirplani, Laila Tul Qadar, Rohan Kumar Ochani, Zahid Ali Memon, Syeda Anjala Tahir, Khalid Imran, Naresh Kumar Seetlani, Amanullah Abbasi, Mahaish Kumar, Piyar Ali

Section of Internal Medicine

Introduction Spontaneous bacterial peritonitis (SBP) is the most common life-threatening infection in patients with ascites due to liver cirrhosis. The infection is most commonly caused by the bacterium Escherichia coli, commonly referred to as E. coli. Over the past few years, the incidence of antimicrobial resistance against E. coli has risen drastically, leading to increased morbidity and mortality. Methods This cross-sectional study was conducted to determine the pattern of resistance using variations of antibiotics against E. coli, to prevent its empirical usage and initiate an appropriate target antibiotic therapy. The data were collected from May 2017 to October 2017 and …

Ralstonia Pickettii Bacteremia: An Emerging Infection In A Tertiary Care Hospital Setting, Nosheen Nasir, Muneeba Ahsan Sayeed, Bushra Jamil

Section of Internal Medicine

Ralstonia species are Gram-negative bacilli that have increasingly been recognized as emerging nosocomial pathogens, particularly in immunocompromised hosts. Ralstonia pickettii is the most clinically important pathogen from the Ralstonia genus. Nosocomial outbreaks of Ralstonia pickettii infections brought about by the use of contaminated medical solutions, including saline, sterile water, as well as disinfectants, have been reported. There have been case reports of invasive infections with variable presentations. Here, we describe three cases of Ralstonia pickettii bacteremia during a period of one year in a tertiary care hospital in Karachi, Pakistan. The first case was a 76-year-old male, known case of …

Metastatic Breast Cancer In Kenya: Presentation, Pathologic Characteristics, And Patterns-Findings From A Tertiary Cancer Center, Etoroabasi Ekpe, Asim Jamal, Jasmit Shah, Judith S. Jacobson, Shahin Sayed

Internal Medicine, East Africa

Purpose: The purpose of this research was to describe the sociodemographic and clinical characteristics of Kenyan women with metastatic breast cancer diagnosed and treated at Aga Khan University Hospital in Nairobi, Kenya from 2012 to 2018.

Patients and Methods: We reviewed charts of Kenyan women with metastatic breast cancer and analyzed sociodemographic data, breast cancer risk factors, and tumor characteristics associated with stage at diagnosis, receptor status (ie, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 [HER2]), and site of metastasis using χ2, analysis of variance, two-sample t tests, and logistic regressions.

Results: A total of 125 …

Performance Of The Timi Risk Score In Predicting Mortality After Primary Percutaneous Coronary Intervention In Elderly Women: Results From A Developing Country, Shumaila Furnaz, Musa Karim, Tariq Ashraf, Sajjad Ali, Izza Shahid, Sara Ali, Uzzam Ahmed Khawaja, Muhammad Tanzeel Ul Haque, Muhammad Shariq Usman, Tariq Jamal Siddiqi

Section of Internal Medicine

Background: Despite women undergoing primary percutaneous coronary intervention (PPCI) having a higher rate of adverse outcomes than men, data evaluating prognostic risk scores, especially in elderly women, remains scarce. This study was conducted to validate the predictive value of Thrombolysis in Myocardial Infarction (TIMI) risk score in elderly female patients.

Materials and Methods: This was a retrospective analysis of elderly (>65 years) female patients who underwent PPCI for ST-elevated myocardial infarction (STEMI) from October 2016 to September 2018. Patients' demographic details and elements of TIMI risk score including age, co-morbidities, Killip classification; weight, anterior MI and total ischemic time …

Prevalence And Outcome Of Asymptomatic Cryptococcal Antigenemia In Art Naive And Art Experienced Hiv Patients In Dar Es Salaam, Tanzania, Charles Mandela Makakala

Theses & Dissertations

Introduction: Cryptococcal meningitis (CM) is a highly fatal disease and contributes to about 20% of all-cause mortality in HIV/AIDS. Sub-Saharan Africa is facing substantial challenges in the treatment of the disease; the focus has been shifted towards prevention of the condition in ART-naive patients with CD4 counts of less than 100 cells/μL. Most studies and interventions have been conducted on ART-naive HIV patients despite there being cases and deaths due to cryptococcal meningitis among ART-experienced patients. Recent studies have shown that although there is an increase in ART coverage among HIV patients, this has not affected the incidence of cryptococcal …

Clinical Spectrum And Factors Impacting Outcome Of Candida Auris: A Single Center Study From Pakistan, Muneeba Ahsan Sayeed, Joveria Farooqi, Kauser Jabeen, Safia Awan, S Mahmood

Section of Internal Medicine

Background: An outbreak of Candida auris began globally in 2014 including Pakistan and since then it has emerged as a nosocomial multi-drug resistant pathogen. The aim of this study was to assess the clinical spectrum and outcome of patients, from a single center in Pakistan, in whom C. auris was isolated.

Methods: A retrospective study was conducted on 92 patients; ≥16 years with at least one culture positive for C. auris, at the Aga Khan University Hospital Karachi, Pakistan from Sept 2014-Mar 2017.Demographics, clinical history, management and outcome were studied. A logistic regression model was used to identify the risk …

A Case Of An Anomalous Right Coronary Artery Arising From The Left Coronary Cusp, Muhammad Shabbir Rawala, Ahmer A. Longi, Arfeen A. Khan, Syed Inam Rizvi, Syed B. Rizvi

Section of Internal Medicine

An anomalous origin of the right coronary artery is usually asymptomatic. It is mostly found incidentally on an invasive diagnostic angiogram. It does lead to an increased risk of sudden cardiac death, especially in younger patients. We present a case of a 41-year-old who had presented to the hospital with complaints of chest pain. The patient was evaluated by cardiology who performed an angiography that identified an anomalous origin of the right coronary artery arising from the left coronary cusp but no evidence of coronary artery disease. Once identified, these anomalous vessels should be corrected surgically, as these conditions increase …

Comparison Of The Sofa And Qsofa Scores In Predicting In-Hospital Mortality Among Adult Critical Care Patients With Suspected Infection., Mohammed Said

Theses & Dissertations

Background: Sepsis is global health priority and the commonest cause of death in critical care. SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis, uses qSOFA and SOFA scores in place of the SIRS based definition for better prediction of mortality in patients with suspected infections. Their performance in predicting mortality in critical care units outside high- income countries remains largely unknown.

Objective: We compared the SOFA and qSOFA scores in predicting the hospital mortality of adult critical care patients admitted with suspected infection at the Aga Khan University Hospital Nairobi, Kenya.

Methods: We did a …

The Use Of Folic Acid In Dengue: Has It Any Value?, Asif Ali Shah, Ahsan Ali Syed, Saad Bin Zafar, Safia Awan

Section of Internal Medicine

Folic acid is used in dengue patients. Our study aims to compare the duration of recovery of thrombocytopenia in patients with dengue infection who received folic acid and those who did not. We retrospectively reviewed the medical records of adult patients admitted over six years with a diagnosis of dengue. Of 2216 patients, 1464 fulfilled the inclusion criteria. Group A were those patients who received folic acid and group B were those who did not. A total of 1322 (90.3%) patients received folic acid. The mean time period required for platelets to double the nadir was 1.7 (±2.2) days in …

Antimicrobial Susceptibility Patterns Of Salmonella Species In Southern Pakistan, Ghulam Shabbir Laghari, Zahid Hussain, Syed Zohaib Maroof Hussain, Haresh Kumar, Syed Mohammad Mazhar Uddin,, Aatera Haq

Section of Internal Medicine

Introduction Typhoid fever is a major infectious disease among the pediatric population of Pakistan. With inappropriate use of antibiotics and rising trends of multidrug-resistant (MDR) and extended drug-resistant (XDR) typhoid, it is becoming a public health emergency. This study evaluated the current trends in antibiotic susceptibilities to Salmonella (S) typhi and paratyphi A, B, and C in southern Pakistan. Materials and methods This cross-sectional study, conducted in the Pediatrics Department, Civil Hospital, Jamshoro from July to December 2018, included children with S. typhi and S. paratyphi A and B strains isolated from the laboratory-based culture of blood samples. Results There …

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation Of Program Impact On Health Care Providers' Knowledge And Treatment Of Hypertension, Elijah N. Ogola, Francis O. Okello, Jane L. Herr, Elizabeth Macgregor-Skinner, Ashling Mulvaney, Gerald Yonga

Internal Medicine, East Africa

Background: Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public.

Objective: The impact of Healthy Heart Africa on HCPs' knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study.

Methods: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, …

Assessment Of Clinical Outcomes In Patients Presenting With Transverse Myelitis: A Tertiary Care Experience From A Developing Country, Aijaz Ali, Syeda Beenish Bareeqa, Amir Riaz, Syed Ijlal Ahmed,, Muhammad Hassan Shaikh, Muhammad Ishaq Ghauri

Department of Medicine

Background: Transverse myelitis (TM) is an inflammatory disorder of spinal cord, characterized by acute or sub-acute dysfunction of spinal cord affecting the motor, sensory, and autonomic systems. It may be idiopathic or related to other diseases. Although some patients recover from TM with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Our objective was to determine the frequency of different clinical outcomes in patients presenting with TM.

Methods: It was a prospective cohort clinical study conducted from May 2018 till October 2018. Study was conducted in the Department …

Adult-Onset Still’S Disease Triggered By Pregnancy, Saleem Abdulkarim, Fredrick Otieno, Sayed Karar

Internal Medicine, East Africa

Adult-onset Still’s disease (AOSD) is an inflammatory disorder with arthritis, quotidian fever, evanescent rash, elevated white cell count, elevated ferritin, and abnormal liver function tests. The diagnosis requires the exclusion of other inflammatory, infectious, and malignant conditions. Onset of AOSD, though rare, has been known to occur in pregnancy. We present a 28-year-old woman diagnosed with AOSD at 3 months gestation.

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 …

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 …

Factors Associated With Cardiac Dysfunction Following Anthracyline-Based Chemotherapy In Adults In A Tertiary Hospital In Nairobi, Joseph Odunga Abuodha

Theses & Dissertations

Introduction: Anthracyclines are known to improve survival in some malignancies, but may also be associated with irreversible cardiotoxicity, which is partly dose dependent. Early detection of cardiotoxicity provides an opportunity for treatment adjustment. Several parameters predict development of clinically manifest cardiac dysfunction. The study aimed to evaluate clinical and echocardiographic parameters which predict development of cardiac dysfunction in a sub-Saharan African population.

Methods: Patients with a diagnosis of cancer and receiving anthracyclines at AKUH,N were evaluated if they met eligibility criteria (≥18years at first anthracycline administration, archived baseline echocardiogram, no prior history of heart disease or use of anthracyclines). …

Barriers To Definitive Hyper-Acute Management Of Stroke At A Tertiary Facility In Nairobi, Kenya, Caroline Wangui Mithi

Theses & Dissertations

Background: Stroke is a sudden neurological deficit due to a vascular cause, which can be ischaemic, haemorrhagic stroke or another cause. It is a leading cause of disability and long term functional impairment in the world. The definitive management of an acute ischaemic stroke is thrombolysis and/or mechanical thrombectomy, both of which has been shown to improve functional outcome but the utilization remains quite low in most hospitals, especially in Africa. This is due to certain pre-hospital and in-hospital barriers, and these factors have been shown to differ from country to country.

Objective: To determine the pre-hospital barriers that prevent …

Using Cirupa To Help Foster Communication With Families About Brain Death In Sub‑Saharan Africa, Sayed Karar, Anthony Ochola, Fatima Juma, Feroza Daroowalla

Internal Medicine, East Africa

Brain death, with a functioning cardiovascular system, remains a difficult issue to grasp for most families. Furthermore, conversations about brain death remain challenging even for the most experienced physicians. We developed an acronym, CIRUPA, to further improve the goals of care conversations in patients diagnosed with brain death. To our knowledge, this is the first acronym within Sub‑Saharan Africa, which helps provide a structured method on how to foster conversations centered around brain death.

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

Theses & Dissertations

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 …

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. …