Medicine and Health Sciences Commons^™

Blackwater Fever And Acute Kidney Injury In Children Hospitalized With An Acute Febrile Illness: Pathophysiology And Prognostic Significance, Andrea Conroy, Michael Hawkes, Aleksandra Leligdowicz, Ivan Mufumba, Michelle Starr, Kathleen Zhong, Sophie Namasopo, Robert Opoka, Chandy John, Kevin C. Kain

Paediatrics and Child Health, East Africa

Background: Acute kidney injury (AKI) and blackwater fever (BWF) are related but distinct renal complications of acute febrile illness in East Africa. The pathogenesis and prognostic signifcance of BWF and AKI are not well understood.

Methods: A prospective observational cohort study was conducted to evaluate the association between BWF and AKI in children hospitalized with an acute febrile illness. Secondary objectives were to examine the association of AKI and BWF with (i) host response biomarkers and (ii) mortality. AKI was defned using the Kidney Disease: Improving Global Outcomes criteria and BWF was based on parental report of tea-colored urine. Host …

Practices Of Vitamin D Supplementation Leading To Vitamin D Toxicity: Experience From A Low-Middle Income Country, Siraj Muneer, Imran Siddiqui, Hafsa Majid, Nawazish Zehra, Lena Jafri, Aysha Habib

Department of Pathology and Laboratory Medicine

Introduction: The trend of prescribing VD preparations for nonspecific body aches and self-medication has increased significantly. The importance of vitamin D toxicity (VDT) has been underestimated and under recognized. This study was done to determine the frequency toxicity (>150 ng/ml) in subjects for 25-hydroxyvitamin D (25OHD) and evaluate the vitamin D (VD) supplements used by these subjects.
Methodology: This descriptive cross-sectional study was conducted at the Section of Chemical Pathology, Aga Khan University Hospital Karachi from April 2020 to March 2021. Subjects with 25OHD toxicity were contacted and information related to history of calcium and VD supplementation were collected. …

Effect Of 3 Days Of Oral Azithromycin On Young Children With Acute Diarrhea In Low-Resource Settings: A Randomized Clinical Trial, Antibiotics For Children With Diarrhea (Abcd) Study Group, Tahmeed Ahmed, Farah Naz Qamar, Mohammad Tahir Yousafzai, Shahida Qureshi, Sadia Shakoor, Rozina Thobani, Aneeta Hotwani, Furqan Kabir, Jan Mohammed

Department of Paediatrics and Child Health

Importance: World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth.
Objective: To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear …

Determination Of Reference Interval (Ri) Of Spot Urinary Oxalate To Creatinine Ratio In Children Of Pakistani Origin Under Six Years Of Age: A Cross-Sectional Study, Syed Bilal Hashmi, Lena Jafri, Jamsheer Jehangir Talati, Hafsa Majid, Saqib Hamid Qazi, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

Background: The gold standard screening method of hyperoxaluria in children is using 24-hour urine collection. Urine collection may be cumbersome and challenging for children. Reference intervals (RI) of oxalate for the Pakistani population are not readily available. Therefore we aimed to determine the oxalate to creatinine ratio (Ox: Cr) for Pakistani children <6 years of age.
Materials and methods: A cross-sectional study was conducted at Aga Khan University from June 2018 to October 2019. Random urine samples from apparently healthy children < 6 years were collected and stored at -30°C until analysis after adding 6M HCl. Oxalate was measured on Micro lab 300 using a kit based on oxalate oxidase principle, while creatinine was measured by kinetic Jaffe reaction. Data was analyzed by EP evaluator and SPSS 23. Ox: Cr ratio was calculated and reported with 90% confidence interval (CI) and interquartile range (IQR).
Results: The mean age of study subjects (n=120) was 29 ±22.3 months with an M: F ratio of 1:1. Children of various ethnicities …

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, …

Tuberculosis In Vulnerable Populations In Eastern Mediterranean Region-Implications For Control, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objectives: Socially and economically disadvantaged or "vulnerable" people are at high risk of tuberculosis (TB) and also contribute to active chains of TB transmission. Included in such vulnerable populations are children, women, prisoners, people living with human immunodeficiency virus, the homeless, and displaced people. The ongoing active transmission of TB among such populations is made more difficult to assess and control by difficult access, health inequities, poverty, and other chronic and debilitating health conditions at individual, domestic, and community levels.
Methods: The 22 Eastern Mediterranean Region member states encompass diverse sociopolitical and socioeconomic situations with far-reaching effects on vulnerable populations …

Prevalence And Factors Associated With Intestinal Parasitic Infection Among Children In An Urban Slum Of Karachi., Vikram Mehraj, Juanita Hatcher, Saeed Akhtar, Ghazala Rafique, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Background:Intestinal parasitic infections are endemic worldwide and have been described as constituting the greatest single worldwide cause of illness and disease. Poverty, illiteracy, poor hygiene, lack of access to potable water and hot and humid tropical climate are the factors associated with intestinal parasitic infections. The study aimed to estimate prevalence and identify factors associated with intestinal parasitic infections among 1 to 5 years old children residing in an urban slum of Karachi Pakistan. Methods And Principal
Findings:A cross sectional survey was conducted from February to June 2006 in Ghosia Colony Gulshan Town Karachi, Pakistan. A simple random …

Conclusions And Recommendations Of A Who Expert Consultation Meeting On Iron Supplementation For Infants And Young Children In Malaria Endemic Areas [Conclusions Et Recommandations À L'Issue De La Consultation De L'Oms Sur La Lutte Contre La Carence Martiale Chez Le Nourrisson Et Le Jeune Enfant Dans Les Pays D'Endémie Palustre], L. Allen, R.E. Black, N. Brandes, G. Brittenham, G. Chazot, C Chunming, J. Crawley, B. De Benoist, N. Dalmiya, I. Darnton-Hill, K. Dewey, S. El-Arifeen, O. Fontaine, C. Geissler, H. Haberle, P. Harvey, J. Hasler, C. Hershko, R. Hurrell, M.A. Juma, B. Lonnerdal, B. Lozoff, S. Lynch, H. Martines Salgado, E. Mclean, J. Metz, S. Oppenheimer, Zul Premji, A. Prentice, M. Ramsan, C. Ratledge, R. Stoltzfus, J. Tielsch

Pathology, East Africa

This article presents the results of an expert consultation meeting aimed at evaluating the safety and public health implications of administering supplemental iron to infants and young children in malaria-endemic areas. Participants at this meeting that took place in Lyon, France on June 12-14, 2006 reached consensus on several important issues related to iron supplementation for infants and young children in malaria-endemic areas. The conclusions in this report apply specifically to regions where malaria is endemic.

Flow Cytometric Analysis Of Childhood Leukemias, R. Z. Yusuf, Shahid Pervez, S. A. Aziz, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To collect demographic data for childhood (less than 15 years) leukemias in Karachi, describe the accuracy of the cell surface markers routinely used in the flow cytometric analysis of leukemic cells and arrive at an ideal panel of antibodies for analyzing leukemic samiples.

Materials and Methods: Data from 62 consecutive cases of childhood leukemias referred to the Department of Pathology, Aga Khan University Hospital. (AKUH) between January 1995 and December 1998 was analyzed using Epi Info Version 6. Flow cytometry on all samples was performed using standard protocols.

Results: The mean age of patients was 8.2 years and 49 …

Acute Haemolysis In Childhood Falciparum Malaria, H. Ekvall, P. Arese, F. Turrini, K. Ayi, F. Mannu, Zul Premji, A. Bjorkman

Pathology, East Africa

Acute haemolysis associated with clinical episodes of high-level Plasmodium falciparum parasitaemia was studied in 20 children from an holoendemic area (coastal Tanzania). The change in blood haemoglobin (Hb) concentration ranged from -46 to +5 g/L during the 72-h observation period and was linearly related to maximum parasitaemia. Balance studies between loss of blood Hb, increase in plasma Hb and appearance of Hb in the urine indicated that extravascular clearance of red cells was the predominant mode of erythrocyte clearance. Most subjects, however, showed minor signs of intravascular haemolysis. The plasma Hb was ≪1% of blood Hb and haemoglobinuria was detected …

An Analysis Of Anemia And Child Mortality, B.J. Brabin, Zul Premji, F. Verhoeff

Pathology, East Africa

The relationship of anemia as a risk factor for child mortality was analyzed by using cross-sectional, longitudinal and case-control studies, and randomized trials. Five methods of estimation were adopted: 1) the proportion of child deaths attributable to anemia; 2) the proportion of anemic children who die in hospital studies; 3) the population-attributable risk of child mortality due to anemia; 4) survival analyses of mortality in anemic children; and 5) cause-specific anemia-related child mortality. Most of the data available were hospital based. For children aged 0-5 y the percentage of deaths due to anemia was comparable for reports from highly malarious …

Frequency Of Malignant Solid Tumors In Children, Sajid Hussain Shah, Shahid Pervez, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

Objective: To find out the frequency of malignant solid tumors in children (cTl5 years).

Setting: All cases of pediatric malignant solid tumors which were diagnosed in the section of histopathology at the Aga Khan University Hospital, Karachi during the period of two years.

Methods: These tumors were initially evaluated on H&E stained sections and special stains were also performed whenever indicated. The undifferentiated tumors were evaluated immunohistochemically by using a panel of antibodies on sections from routinely processed, fornialin fixed, paraffin embedded tissu.e blocks.

Results: Of two hundred and fifty three (253) consecutive cases of paediatric malignant solid tumors, lyinphorna …

Childhood Non-Hodgkin's Lymphoma: An Immunophenotypic Analysis., Sajid Hussain Shah, Suhail Muzaffar, Shahid Pervez, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

Objective: To observe the frequency of histological subtypes of childhood non-Hodgkin`s lymphoma and its immunohistochemical profile.

Setting: All cases of non-Hodgkin’s lymphoma diagnosed in children (<15 years) in the section of histopithology at the Aga Khan University Hospital Karachi during the period of three years.

Methods: These consecutive cases were evaluated on H&E stained sections and then immunohistochemistry analysis of these tumors was performed by employing Peroxidase Anti-Peroxidase (PAP) technique.

Results: The present series included 61 cases of non-Hodgkin’s lymphoma. NHL was more common in males as compared to females with male to female ratio of 5.8:1. High grade NHL comprised 87% of childhood lymphoma. The mode of presentation in majority of NHL (57%) was extranodal. Burkitt’s lymphonia (33%) …

Spectrum Of Hodgkin's Disease In Children And Adults: Impact Of Combined Morphologic And Phenotypic Approach For Exclusion Of Look-Alikes, Tanya Siddiqui, Shahid Pervez

Department of Pathology and Laboratory Medicine

Objective:

To determine the prevalence of Hodgkin’s disease (HD) and its various subtypes in children and adults and assess the use of immunohistochemical (IHC) studies in confirming HD cases and excluding its close mimicries/look-alikes.

Material and Methods:

All 265 Hodgkin’s disease cases diagnosed at The Aga Khan University Hospital, Karachi over the last 6 years (July 1991 - July 1997) were included. Of these 219 were diagnosed on routine H&E examination while in the remaining 46 cases, diagnosis was made after a thorough IHC workup. (This group initially included 161 cases labelled as lymphoproliferative disorder with HD as one of …