Medicine and Health Sciences Commons^™

Sensitivity Of A Preanaesthesia Screening And Triage Tool In Identifying High Risk Patients: A Diagnostic Accuracy Study, Brian Kiplagat Misoi

Master of Medicine in General Surgery

Introduction; Preoperative evaluation and optimization is conducted to prepare a sound perioperative management plan and limit complications. The standard of assessment is by the anesthesiologist based on ASA recommendations, and can be conducted early in the PAC or on the operative day. Reviews in the PAC have been shown to allay anxiety and reduce day of surgery cancellation. While it is ideal for all patients to be evaluated preoperatively by the physician anesthesiologist in the PAC, there are very few anaesthesiologist's in low and middle income countries meaning this may be unachievable. This creates a demand for innovative ways to …

Survival Outcomes And Prognostic Factors Affecting Survival In Patients With Metastatic Breast Cancer, Mwongeli Matheka

Master of Medicine in General Surgery

Introduction: There is an increase in breast cancer in Africa with up to 77% of patients diagnosed with advanced disease. Late diagnosis, aggressive tumor biology and inadequate or incomplete treatments contribute to high mortality rates. However, there is little data on survival outcomes and prognostic factors affecting survival in patients with metastatic breast cancer (MBC) in Africa. The study objective was to establish the survival of patients with MBC at a single tertiary health facility and to outline the clinical and pathological characteristic of the patients and their relation to survival outcomes. Methods: This was a retrospective descriptive study conducted …

Outcomes Of Cardiac Surgery At The Aga Khan University Hospital Nairobi – A One Year Review, Nelly Joseph Kahamba

Master of Medicine in General Surgery

Background: Cardiovascular diseases are the number one cause of death worldwide where an estimated 17.9 million people die yearly, according to WHO. Most of this disease burden lies in the low and middle-income countries. Management of cardiovascular diseases can be medical and/or surgical. Open heart surgery is one among the major surgeries performed worldwide. It is well established in high income countries where up to 200,000 cardiac surgeries can be performed yearly. In low-income countries particularly sub-Saharan Africa where most of the disease burden is, there are about 22 centres that cater to this growing need for cardiac surgery. There …

Performance In Mortality Prediction Of Saps 3 And Mpm0-Iii Scores Among Adult Patients Admitted To The Icu Of A Private Tertiary Referral Hospital In Tanzania, Nadeem Kassam

Master of Medicine in Internal Medicine

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the intensive care unit. They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified acute physiology score (SAPS 3) and Mortality probability models (MPM0-III) in predicting ICU outcome as well as identified disease pattern and clinical factors associated with increased mortality. Methods This was a retrospective cohort study of adult patients admitted to the Intensive Care Unit (ICU) of the Aga Khan …

Correlation Between Disease Severity And Health-Related Quality Of Life Among Patients With Fibromyalgia Syndrome, Janet Chebet Koros

Master of Medicine in Internal Medicine

Background: Fibromyalgia Syndrome is a rheumatic disorder characterized by chronic widespread musculoskeletal pain accompanied by fatigue, sleep, memory problems, and mood disturbances. Little is known about the characteristics of fibromyalgia patients in Kenya. Studies done elsewhere have shown that patients with fibromyalgia syndrome incur more healthcare costs, have a higher prevalence of comorbidities, have more workdays missed, have poor productivity, retire early, have impaired function, and lead a poorer quality of life. Methods: This study was a prospective cross-sectional study that enrolled patients diagnosed with fibromyalgia syndrome attending the rheumatology clinic at the Aga Khan University Hospital Nairobi, Kenya. Those …

Validity And Acceptability Of The Kiswahili-Paediatric Gait, Arms, Legs And Spine (Pgals) Screening Tool At A Tertiary Referral Hospital In Kenya, Jacqueline Evarist Kawishe

Master of Medicine in Paediatrics and Child Health

Background: A common reason implicated in the severity of presentation and mortality resulting from rheumatic conditions among children is the delayed presentation to a paediatric rheumatologist. Evidence suggests low-quality paediatric musculoskeletal clinical skills could be a cause for diagnostic delay and history suggestive of musculoskeletal disease alone has poor sensitivity in detecting paediatric rheumatic conditions. The paediatric gait, arms, legs, and spine (pGALS) musculoskeletal screening tool was developed to encourage early detection of paediatric rheumatic conditions. It has been validated and translated successfully in other countries. Kiswahili serves as a national language in several East African countries. Translating and validating …

Efficacy Of Nerve Blocks On Immediate Post Caesarean Delivery Functionality, Dorothy Makena

Master of Medicine in Obstetrics and Gynecology

Introduction; Caesarean section is becoming increasingly common and is one of the most performed procedures globally. It is a major surgery accompanied by moderate to severe pain. Pain impacts negatively on functionality of the mother in terms of daily activities like self-care, newborn care and mobility. A post caesarean section mother therefore requires effective and safe pain relief to improve functionality, for effective breastfeeding and to reduce the risk of venous thromboembolism. Abdominal plane nerve blocks have been studied widely in the recent past and have been shown to be effective as part of multimodal post caesarean analgesia. This study …

Prevalence Of Depression And Factors Associated With Depressive Symptoms Among Patients Diagnosed With Benign Prostatic Enlargement At Aga Khan University Hospital, Nairobi, Husni Abdalla

Master of Medicine in Family Medicine

Background: There is a relationship between Benign Prostatic Enlargement (BPE) and Lower Urinary Tract Symptoms (LUTS). The persistence of LUTS can negatively affect the quality of living by interrupting daily activities. Depressive symptoms occur commonly in patients with BPE. Depression is a taboo subject in Africa, and Kenya is no exception. Depression at its worst can lead to suicide. Thus, it is of great importance to recognise the factors associated with depressive symptoms in patients with BPE and hence reinforce the need to assess depression in patients with BPE in our clinical practice. Objective: This study sought to determine the …

A Clinical Audit Of Management Of Third And Fourth Degree Perineal Tears, Saida Abrar, Raheela Mohsin Rizvi, Urooj Kashif

Department of Obstetrics & Gynaecology

Objective: To perform a clinical audit of the practices related to the management of third and fourth degree perineal tears.
Methods: The retrorspective study was conducted in 2019 at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2008 to December 2018 of women having singleton term vaginal delivery and sustaining obstetric anal sphincter injuries. The change in practices regarding tear management was compared with a previous audit done at the same institution in 2008. Data was analysed using SPSS 20.
Results: Of the 25,370 deliveries, 142(0.56%) sustained obstetric anal sphincter injuries. There was a significant increase …

Chikungunya Outbreak In Karachi Pakistan 2016-2017: An Analysis Of Viral Isolates, Dhani Prakoso, Kelli Barr, Kehkashan Imtiaz, Joveria Farooqi, Erum Khan, Maureen Long

Department of Pathology and Laboratory Medicine

In December 2016 physicians in Karachi, Pakistan,witnessed an increase in patients presenting with febrile illness and severe polyarthralgia. Subsequently, chikungunya virus (CHIKV)) was isolated from three patients. This virus was sequenced and compared with other isolates of CHIKV obtained in India and Pakistan during recent outbreaks. Phylogenetic analysis indicated that the Karachi isolates were most similar to the East Central South African CHIKV lineage and showed sequence homology to isolates obtained in other parts of Pakistan and India. More importantly, two of the CHIKV isolates had a nucleotide substitution in the E1 gene corresponding to an amino acid change at …

Prevalence And Mortality Of Epilepsies With Convulsive And Non-Convulsive Seizures In Kilifi, Kenya, Symon M. Kariuki, Anthony Ngugi, Martha Z. Kombe, Michael Kazungu, Eddie Chengo, Rachael Odhiambo, Amek Nyaguara, Brian G. Neville, Charles Rjc Newton

Population Health, East Africa

Objectives: The prevalence of all epilepsies (both convulsive and non-convulsive seizures) in Low- and Middle- Income Countries (LMIC), particularly sub-Saharan Africa is unknown. Under estimation of non-convulsive ep- ilepsies in data from these countries may lead to inadequate and sub-optimal allocation of resources to control and prevent epilepsy. We determined the prevalence of all types of epilepsies and compared the mortality be- tween convulsive seizures and non-convulsive seizures in a resource limited rural area in Kenya.

Methods: Trained clinicians identified cases of epilepsy in a randomly selected sample of 4,441 residents in the Kilifi Health and Demographic Surveillance System site …

Effect Of Community-Based Interventions Targeting Female Sex Workers Along The Hiv Care Cascade In Sub-Saharan Africa: A Systematic Review And Meta-Analysis, Lydia Atuhaire, Olatunji Adetokunboh, Constance Shumba, Peter S. Nyasulu

School of Nursing & Midwifery, East Africa

Background: Female sex workers are extremely vulnerable and highly susceptible to being infected with human immunodeficiency virus. As a result, community-based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. We conducted a systematic review to (1) assess the effect of FSW-targeted community interventions on the improvement of HIV services access along the treatment cascade and (2) describe community-based interventions that positively affect continuation in HIV care across the HIV treatment cascade for FSWs in sub-Saharan Africa.

Methods: We defined the 5 steps that …

Prevalence Of The Use Of Herbal Medicines Among Patients With Cancer: A Systematic Review And Meta-Analysis, John Baptist Asiimwe, Prakash B. Nagendrappa, Esther C. Atukunda, Mauda M. Kamatenesi, Grace Nambozi, Casim U. Tolo, Patrick E. Ogwang, Ahmed Sarki

School of Nursing & Midwifery, East Africa

Background: Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. )e purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories).

Methods: Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies …

Harnessing Social Media In Mental Health Practice In Kenya: A Community Case Study Report, Linnet Ongeri, Gathoni Mbugua, Frank Njenga, Anna Nguithi, Jacqueline Anundo, Maryann Mugane, Zawadi Kimari, Loice Wanjiru Cushny Kaigwa, Lukoye Atwoli

Internal Medicine, East Africa

The use of social media to increase awareness on mental health is rapidly gaining momentum globally. However, despite evidence of a growing trend in social media use in sub Saharan Africa, little has been reported on tapping the potential of social media within a mental health practice to not only increase awareness but also facilitate linkage to specialist care. We describe one such mental health practice and its process of integration of the different social media platforms to promote mental health and increase linkage to specialist care. We further highlight the challenges and practical implication of social media use in …

Needs Of Young African Neurosurgeons And Residents: A Cross-Sectional Study, Ulrick S. Kanmounye, Faith C. Robertson, Nqobile S. Thango, Alvin Nah Doe, Nourou Dine Adeniran Bankole, Pape Aicha Ginette, Solomon Ondoma, James A. Balogun, Beverly Cheserem, Mahmood Qureshi

General Surgery, East Africa

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice.

Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant.

Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, …

Impact Of Acne On Quality Of Life In Young Pakistani Adults And Its Relationship With Severity: A Multicenter Study, Shaheen Naveed, Sadia Masood, Atiya Rahman, Safia Awan, Saadia Tabassum

Department of Medicine

Objectives: The current study aimed to determine the effect of acne vulgaris on quality of life of young adults and to assess the correlation between acne severity and impairment of quality of life (QOLI).
Methods: In this multi-center cross-sectional study, 163 young adults with acne vulgaris were assessed for severity and quality of life impairment between December 2016 and May 2017 at three tertiary care hospitals. Cardiff Acne Disability Index (CADI) was used to assess the quality of life while the severity of acne measured by Global Acne Grading System (GAGS). Data were collected on standardized forms, with CADI, GAGS …

How Covid-19 Has Fundamentally Changed Clinical Research In Global Health, Jay J H. Park, Robin Mogg, Gerald E. Smith, Etheldreda Nakimuli-Mpungu, Fyezah Jehan, Craig R. Rayner, Jeanine Condo, Eric H. Decloedt, Jean B. Nachega, Gilmar Reis, Edward J. Mills

Department of Paediatrics and Child Health

COVID-19 has had negative repercussions on the entire global population. Despite there being a common goal that should have unified resources and efforts, there have been an overwhelmingly large number of clinical trials that have been registered that are of questionable methodological quality. As the final paper of this Series, we discuss how the medical research community has responded to COVID-19. We recognise the incredible pressure that this pandemic has put on researchers, regulators, and policy makers, all of whom were doing their best to move quickly but safely in a time of tremendous uncertainty. However, the research community's response …

The Role And Challenges Of Cluster Randomised Trials For Global Health, Louis Dron, Monica Taljaard, Yin Bun Cheung, Rebecca Grais, Nathan Ford, Kristian Thorlund, Fyezah Jehan, Etheldreda Nakimuli-Mpungu, Denis Xavier, Zulfiqar Ahmed Bhutta, Jay J H. Park, Edward J. Mills

Department of Paediatrics and Child Health

Evaluating whether an intervention works when trialled in groups of individuals can pose complex challenges for clinical research. Cluster randomised controlled trials involve the random allocation of groups or clusters of individuals to receive an intervention, and they are commonly used in global health research. In this paper, we describe the potential reasons for the increasing popularity of cluster trials in low-income and middle-income countries. We also draw on key areas of global health research for an assessment of common trial planning practices, and we address their methodological shortcomings and pitfalls. Lastly, we discuss alternative approaches for population-level intervention trials …

Urgently Seeking Efficiency And Sustainability Of Clinical Trials In Global Health, Jay J H. Park, Rebecca F. Grais, Monica Taljaard, Etheldreda Nakimuli-Mpungu, Fyezah Jehan, Jean B. Nachega, Nathan Ford, Denis Xavier, Andre P. Kengne, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

This paper shows the scale of global health research and the context in which we frame the subsequent papers in the Series. In this Series paper, we provide a historical perspective on clinical trial research by revisiting the 1948 streptomycin trial for pulmonary tuberculosis, which was the first documented randomised clinical trial in the English language, and we discuss its close connection with global health. We describe the current state of clinical trial research globally by providing an overview of clinical trials that have been registered in the WHO International Clinical Trial Registry since 2010. We discuss challenges with current …

Exploring Equity In Health And Poverty Impacts Of Control Measures For Sars-Cov-2 In Six Countries, Sedona Sweeney, Theo Prudencio Juhani Capeding, Rosalind Eggo, Maryam Huda, Mark Jit, Don Mudzengi, Nichola R. Naylor, Simon Procter, Matthew Quaife, Lela Serebryakova

Community Health Sciences

Background: Policy makers need to be rapidly informed about the potential equity consequences of different COVID-19 strategies, alongside their broader health and economic impacts. While there are complex models to inform both potential health and macro-economic impact, there are few tools available to rapidly assess potential equity impacts of interventions.
Methods: We created an economic model to simulate the impact of lockdown measures in Pakistan, Georgia, Chile, UK, the Philippines and South Africa. We consider impact of lockdown in terms of ability to socially distance, and income loss during lockdown, and tested the impact of assumptions on social protection coverage …

Referral Pattern And Outcomes Of Neonates From Secondary Care Setting Of Aga Khan University Hospital To Tertiary Care Centers In Pakistan, Suneeta Khemani, Nazia Shamim, Adnan Mirza, Nadia Mohammad, Safdar Kagazwala, Shakeel Ahmed

Department of Paediatrics and Child Health

Objective: To determine the reasons of neonatal referrals from secondary-care to tertiary-care setting, and to assess neonatal outcomes for the referred cases.
Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from July 2015 to June 2019 Related to all neonates born after 32 weeks of gestation at the satellite secondary-care centres in Kharadar, Garden and Karimabad who had been referred to the main tertiary care hospital. The reason for referral, need of mechanical ventilation, referral place and neonatal outcome were noted. Data was analysed using SPSS 22.
Results: Of the 348 cases, …

Gastrointestinal Complications In Critically Ill Children: Experience From A Resource-Limited Country, Sidra Ishaque, Mariam Shakir, Asma Akbar Ladak, Anwar Ul Haque

Department of Paediatrics and Child Health

Objectives: To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children.
Methods: This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), The Aga Khan University Hospital (AKUH), Karachi, from September 2015 to January 2017. After obtaining approval from the Ethical Review Committee of AKUH and informed consent from the parents, all children (aged one month to 18 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included. The frequency of the defined GIC: vomiting, high gastric residue volume (GRV), diarrhea, constipation, and …

Cervical Cancer-Associated Suffering: Estimating The Palliative Care Needs Of A Highly Vulnerable Population, Eric L. Krakauer, Xiaoxiao Kwete, Khadidjatou Kane, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa, C R Beena Devi C R Beena Devi

Department of Anaesthesia

Purpose: To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration.
Methods: We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified Delphi process with experts in cervical cancer care to supplement the literature. For each type of suffering, we distinguished between decedents (those who die from cervical cancer in a given year) and nondecedents (those who have cervical cancer in a given year but do not die). By applying …

Clinical Characteristics And Outcomes Of Covid-19: Experience At A Major Tertiary Care Center In Pakistan, Nosheen Nasir, Kiren Habib, Iffat Khanum, Naveera Khan, Zehra Abdul Muhammad, Syed Faisal Mahmood

Section of Internal Medicine

Introduction: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan.
Methodology: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Patients with a discharge diagnosis of COVID-19 and PCR positivity were included. We created logistic regression models to understand association of clinical characteristics with illness severity and in-hospital mortality.
Results: The study population comprised 445 patients [67% males, median age 53 (IQR 40-64) years]. Majority of patients (N = …

Heat Emergencies: Perceptions And Practices Of Community Members And Emergency Department Healthcare Providers In Karachi, Pakistan: A Qualitative Study, Uzma Rahim Khan, Naveed Ahmed, Rubaba Naeem, Umerdad Khudadad, Sarwat Masud, Nadeem Ullah Khan, Junaid Abdul Razzak

Department of Emergency Medicine

Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community …

Determinants Of Short Birth Intervals Among Married Women: A Cross-Sectional Study In Karachi, Pakistan, Sidrah Nausheen, Maria Asif Bhura, Kristy Hackett, Imtiaz Hussain, Zainab Shaikh, Arjumand Rizvi, Uzair Ansari, David Canning, Iqbal Shah, Sajid Bashir Soofi

Department of Obstetrics & Gynaecology

Introduction: Birth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in Karachi, Pakistan.
Methods: We used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the 6 years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history and a 6-year reproductive calendar were …

Exploring Willingness To Pay For Health Insurance And Preferences For A Benefits Package From The Perspective Of Women From Low-Income Households Of Karachi, Pakistan, Shifa Salman Habib, Shehla Zaidi

Community Health Sciences

Background: Achieving universal health coverage (UHC) and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG). In low-middle income countries, micro-health insurance (MHI) schemes have emerged as a useful financing tool for laying grounds for Universal Health Coverage. The aim of this study was to provide evidence for designing a feasible health insurance scheme targeted at urban poor, by exploring preferences for an insurance benefits package and co-payments among women from low-income households in Karachi, Pakistan.
Methods: This was a descriptive cross-sectional study, conducted using household surveys between July-August 2015. …

Violence Against Healthcare Workers During The Covid-19 Pandemic: A Review Of Incidents From A Lower-Middle-Income Country, Omaima Anis Bhatti, Hareem Rauf, Namrah Aziz, Russell S. Martins, Javaid Khan

Medical College Documents

Background: Healthcare workers (HCWs) across the globe have met tremendous challenges during the COVID-19 (coronavirus disease 2019) pandemic, such as shortages of personal protective equipment, extensive work hours, and constant fear of catching the virus or transmitting it to loved ones. Adding on to the already existing burnout, an increase in incidents of violence and aggression against HCWs was seen in Pakistan and globally.
Objectives: Primarily to review cases of violence against HCWs in Pakistan, highlighting and comparing the instigating factors seen within the country and globally. Secondly, to enlist possible interventions to counter workplace violence in healthcare during a …

Maternal And Neonatal Morbidity And Mortality Among Pregnant Women With And Without Covid-19 Infection: The Intercovid Multinational Cohort Study, José Villar, Shabina Ariff, Robert B. Gunier, Ramachandran Thiruvengadam, Stephen Rauch, Alexey Kholin, Paola Roggero, Federico Prefumo, Marynéa Silva Do Vale, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Importance: Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed.
Objective: To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals.
Design, setting, and participants: In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were …

Respiratory Pathogens In Patients With Acute Exacerbation Of Non-Cystic Fibrosis Bronchiectasis From A Developing Country, Shayan Shahid, Kausar Jabeen, Nousheen Iqbal, Joveria Farooqi, Muhammad Irfan

Medical College Documents

Bronchiectasis unrelated to cystic fibrosis (non-CF bronchiectasis) has become a major respiratory disease in developing nations. The dilated mucus filled airways promote bacterial overgrowth followed by chronic infection, bronchial inflammation, lung injury and re-infection Accurate pathogen identification and antimicrobial susceptibility allowing appropriate treatment, in turn, may break this vicious cycle. To study the spectrum and antimicrobial spectrum of pathogen yielded from respiratory specimens in adult patients with acute exacerbation of non-cystic fibrosis (CF) bronchiectasis. This cross-sectional study was performed at the pulmonology clinics of the Aga Khan University, Karachi, Pakistan from 2016-2019. Respiratory specimens were collected from adult patients with …