Medicine and Health Sciences Commons^™

Pulmonary Scedosporiosis Mimicking Aspergilloma In An Immunocompetent Host: A Case Report And Review Of The Literature, Fasih Ur Rahman, Muhammad Irfan Ul Haq, Naima Fasih, Kauser Jabeen

Department of Surgery Docs

Abstract

A case of localized lung scedosporiosis is reported here that mimicked aspergilloma in an immunocompetent host. Through this case the importance of considering Scedosporium spp. in differential diagnosis of locally invasive lung infections and fungal ball is highlighted. As it is difficult to differentiate Scedosporium from Aspergillus on clinical grounds, microscopy, radiology and histopathology, this case is further emphasizing the significance of the definitive etiological characterization of Scedosporium through culture or molecular diagnostic tools. Accurate identification of Scedosporium, surgical resection and high-dose voriconazole has been associated with favorable outcome in most reported cases of scedosporiosis.

Squamous Cell Carcinoma Of Oral Tongue In Young Patients — A 10 Years Tertiary Care Experience, Shakeel Uz Zaman, Muhammad Adeel, Anwar Suhail

Department of Surgery Docs

Abstract

OBJECTIVE:

To evaluate the clinical and pathological profile of young patients with squamous cell carcinoma of tongue.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of patients20.

RESULTS:

Of the 29 patients, 17(58.6%) were men and 12(41.3%) were women. The overall mean age at presentation was 29.6+/-4.4 years. All patients (100%) had some sort of addiction, with 15(51.7%) having more than one addiction. Of the total, 20(68.9%) patients had moderately differentiated carcinoma. At presentation, 20(68.9%) had advanced stage (III-IV) disease. Surgery was the primary modality used in all the patients (100%). Median …

Inefficient Dmn Suppression In Schizophrenia Patients With Impaired Cognitive Function But Not Patients With Preserved Cognitive Function, Li Zhou, Weidan Pu, Jingjuan Wang, Haihong Liu, Guowei Wu, Chang Liu, Tumbwene Mwansisya, Haojuan Tao, Xudong Chen, Dongsheng Lv

School of Nursing & Midwifery, East Africa

Previous studies have observed reduced suppression of the default mode network (DMN) during cognitive tasks in schizophrenia, suggesting inefficient DMN suppression is critical for the cognitive deficits of schizophrenia. Cognitive function in schizophrenia patients, however, varies from relatively intact to severely impaired. This study, which compared the DMN suppression patterns between first-episode schizophrenia patients with (SZ-Imp) and without (SZ-Pre) impaired cognitive function, may provide further insight into the role of DMN dysfunction in cognitive deficits of schizophrenia. Independent component analysis (ICA) was applied to resting-state fMRI data to identify the DMN in each subject, and then general linear modeling based …

Geographic Access To Working Family Planning Centers And Unintended Pregnancies Among Married Women: A Community Based Nested Case Control Study., Sumera Aziz Ali, Sarah Saleem, Neelofar Sami, Mir Shabbar, Muhammad Ahmed, Shafquat Rozi, Robert L. Goldenberg, Margo S. Harrison, Omrana Pasha

Community Health Sciences

Background:

Unintended pregnancies pose substantial risk to mothers and children. In Pakistan, unintended pregnancies account for 46% of all pregnancies. Lack of geographic access to open and well-supplied family planning (FP) centers may be related to the occurrence of such pregnancies, particularly in rural areas.

Objective:

The objective of this analysis is to determine if geographic access to family planning centers in the Thatta district of Pakistan is related to unintended pregnancy rates among married women.

Methods:

We conducted a community-based, nested case-control study of 800 pregnant women identified from the database of an active surveillance system, which registers and …

Primary Angiosarcoma Of Breast, Saroona Haroon, Naveen Faridi, Faisal Rashid Lodhi

Department of Pathology and Laboratory Medicine

Primary breast sarcomas, except for phyllodes tumour, are very rare entities, accounting for < 0.1% of all malignant neoplasms. Angiosarcoma of breast is infrequent malignancy and differential diagnosis from other sarcomatous and angiomatous breast tumours holds importance. Two cases of primary angiosarcoma of breast were encountered. One involved a 32 years lady who was treated by wide local excision and six cycles of chemotherapy. The other occurred in a 54 years old lady who was treated with mastectomy, did not receive any radiation or chemotherapy and was later lost to follow-up. Neither of the patient had history of previous breast surgery, chemotherapy or radiotherapy.

Spectrum Of Microbial Diseases And Resistance Patterns At A Private Teaching Hospital In Kenya: Implications For Clinical Practice, Daniel Maina, Geoffrey Omuse, Gunturu Revathi, Rodney Adam

Pathology, East Africa

Background: Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data.

Methods: We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity …

Evidence And Knowledge Gaps On The Disease Burden In Sexual And Gender Minorities: A Review Of Systematic Reviews, Karel Blondeel, Lale Say, Doris Chou, Igor Toskin, Rajat Khosla, Elisa Scolaro, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Sexual and gender minorities (SGM) include individuals with a wide range of sexual orientations, physical characteristics, and gender identities and expressions. Data suggest that people in this group face a significant and poorly understood set of additional health risks and bear a higher burden of some diseases compared to the general population. A large amount of data is available on HIV/AIDS, but far less on other health problems. In this review we aimed to synthesize the knowledge on the burden of communicable and non-communicable diseases, mental health conditions and violence experienced by SGM, based on available systematic reviews. We conducted …

Cerebellopontine Angle Primitive Neuroectodermal Tumor Mimicking Trigeminal Schwannoma, Saad Akhtar Khan, Badar Uddin Ujjan, Adnan Salim, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Primitive neuroectodermal tumors (PNETs) comprise a group of aggressive, poorly differentiated embryonal tumors occurring in central nervous system as well as in peripheral locations. Primary cerebellopontine angle (CPA) PNET is an extremely rare entity. It is important to have knowledge of this pathology and to be able to differentiate it from other commonly occurring CPA tumors, such as vestibular and trigeminal schwannomas. This distinction is essential because of the difference in the overall treatment plan and prognosis.
Case description: This report describes a case of a young male presenting with diplopia and numbness of face; magnetic resonance imaging showed …

Fibroblast Growth Factor 23 (Fgf23) Levels, Phosphate Intake And Its Association With Indices Of Renal Handling Of Phosphate In Healthy Volunteers, Noreen Abbas, Aysha Habib Khan, Farooq Ghani, Imran Siddiqui

Department of Pathology and Laboratory Medicine

FGF23 is a novel phosphaturic hormone; we aimed to assess the FGF23 levels and its association with dietary phosphate intake and indices of renal handling of phosphate in this study. Prospective study was conducted in which dietary phosphate intake was assessed by food frequency questionnaire (FFQ) along with blood and spot urine samples were collected after overnight fast for determining serum phosphate, FGF23, fractional excretion of phosphate (FePO4 ) and tubular maximum for phosphate (TmP/GFR). FGF23 (C-Term) was measured by a sandwich ELISA. The mean dietary phosphate intake of eighty healthy adults (mean age of 29 ± 5 years) was …

Genomic Diversity Of Epec Associated With Clinical Presentations Of Differing Severity, Tracy H. Hazen, Michael S. Donnenberg, Sandra Panchalingam, Martin Antonio, Anowar Hossain, Inacio Mandomando, John Benjamin Ochieng, Shahida Qureshi, Farheen Quadri, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Enteropathogenic Escherichia coli (EPEC) are diarrhoeagenic E. coli, and are a significant cause of gastrointestinal illness among young children in developing countries. Typical EPEC are identified by the presence of the bundle-forming pilus encoded by a virulence plasmid, which has been linked to an increased severity of illness, while atypical EPEC lack this feature. Comparative genomics of 70 total EPEC from lethal (LI), non-lethal symptomatic (NSI) or asymptomatic (AI) cases of diarrhoeal illness in children enrolled in the Global Enteric Multicenter Study was used to investigate the genomic differences in EPEC isolates obtained from individuals with various clinical outcomes. A …

Simplified Paper Format For Detecting Hiv Drug Resistance In Clinical Specimens By Oligonucleotide Ligation, Nuttada Panpradist, Ingrid A. Beck, Michael Chung, James N. Kiarie, Lisa M. Frenkel, Barry R. Lutz

Internal Medicine, East Africa

Human immunodeficiency virus (HIV) is a chronic infection that can be managed by antiretroviral treatment (ART). However, periods of suboptimal viral suppression during lifelong ART can select for HIV drug resistant (DR) variants. Transmission of drug resistant virus can lessen or abrogate ART efficacy. Therefore, testing of individuals for drug resistance prior to initiation of treatment is recommended to ensure effective ART. Sensitive and inexpensive HIV genotyping methods are needed in low-resource settings where most HIV infections occur. The oligonucleotide ligation assay (OLA) is a sensitive point mutation assay for detection of drug resistance mutations in HIV pol. The current …

High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries: A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar

Section of General Surgery

Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. Inliterature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trau-ma index) as a more accurate method of quantifying the extent of damage in patients with the penetrat-ing abdominal trauma and association of high PATI score (>25) with mortality.
Objective: To determine the association of mortality in patient with penetrating abdominal trauma with …

Response To The Comments: "Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy", Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

An Ethnographic Investigation Of The Maternity Healthcare Experience Of Immigrants In Rural And Urban Alberta, Canada., Gina M. Higginbottom, Jalal Safipour, Sophie Yohani, Beverly O’Brien, Zubia Mumtaz, Patricia Paton, Yvonne Chiu, Rubina Barolia

School of Nursing & Midwifery

BACKGROUND:

Canada is among the top immigrant-receiving nations in the world. Immigrant populations may face structural and individual barriers in the access to and navigation of healthcare services in a new country. The aims of the study were to (1) generate new understanding of the processes that perpetuate immigrant disadvantages in maternity healthcare, and (2) devise potential interventions that might improve maternity experiences and outcomes for immigrant women in Canada.

METHODS:

The study utilized a qualitative research approach that focused on ethnographic research design and data analysis contextualized within theories of organizational behaviour and critical realism. Data were collected over …

Integration Of Health Promotion Into Nursing Practice: A Case Study In Pakistan., Muneerah Vastani, Rozina Karmaliani Professor, Pammla M. Petrucka

School of Nursing & Midwifery

The purpose of this study was to understand the concept of health promotion and perceptions related to the integration of health promotion in nursing practice in Pakistan. The study utilized the qualitative single case study approach to explore and describe the concept of health promotion, its significance and ways to integrate health promotion strategies in nursing practice. The data were collected from three different sources; focus group discussion among final year Post-RN BScN students, key informant interviews of practicing nurses, faculty, and MScN students, as well as a document review of the Post-RN BScN curriculum. Data analysis included a content …

The Diagnostic Accuracy Of Determine™ Tb Lam Antigen In Detection Of Extra Pulmonary Tuberculosis (Eptb), Fatimah Osman Juma

Master of Medicine in Internal Medicine

Background: TB remains a key global health challenge; particularly Extra pulmonary Tuberculosis (EPTB) and is also a major cause of morbidity and mortality in sub-Saharan Africa. The increasing incidence of EPTB compounded by difficulties in making a timely diagnosis portends to poor prognosis and increased mortality. Delays in diagnosis and misdiagnosis of EPTB in suspected patients account for mortality as well. Challenges in diagnosis of EPTB are mainly due to disease related factors, the paucibacillary nature of disease and challenges with sample collection and processing. Reference standard test such as TB culture, geneXpert and histology which are used in the …

Effect Of Provision Of An Integrated Neonatal Survival Kit And Early Cognitive Stimulation Package By Community Health Workers On Developmental Outcomes Of Infants In Kwale County, Kenya: Study Protocol For A Cluster Randomized Trial, Lisa G. Pell, Diego G. Bassani, Lucy Nyaga, Isaac Njagi, Catherine Wanjiku, Thulasi Thiruchselvam, William Macharia, Ripudaman S. Minhas, Patricia Kitsao-Wekulo, Amyn Lakhani, Zulfiqar Ahmed Bhutta, Robert Armstrong, Shaun K. Morris

Paediatrics and Child Health, East Africa

Background: Each year, more than 200 million children under the age of 5 years, almost all in low- and middle-income countries (LMICs), fail to achieve their developmental potential. Risk factors for compromised development often coexist and include inadequate cognitive stimulation, poverty, nutritional deficiencies, infection and complications of being born low birthweight and/or premature. Moreover, many of these risk factors are closely associated with newborn morbidity and mortality. As compromised development has significant implications on human capital, inexpensive and scalable interventions are urgently needed to promote neurodevelopment and reduce risk factors for impaired development.

Method/Design: This cluster randomized trial aims at …

Self-Reported Practices Among Traditional Birth Attendants Surveyed In Western Kenya: A Descriptive Study, Sherri Bucher, Olive Konana, Edward Liechty, Ana Garces, Peter Gisore, Irene Marete, Constance Tenge, Evelyn Shipala, Linda Wright, Fabian Esamai

Paediatrics and Child Health, East Africa

Background: The high rate of home deliveries conducted by unskilled birth attendants in resource-limited settings is an important global health issue because it is believed to be a significant contributing factor to maternal and newborn mortality. Given the large number of deliveries that are managed by unskilled or traditional birth attendants outside of health facilities, and the fact that there is on-going discussion regarding the role of traditional birth attendants in the maternal newborn health (MNH) service continuum, we sought to ascertain the practices of traditional birth attendants in our catchment area. The findings of this descriptive study might help …

Setting Research Priorities To Improve Global Newborn Health And Prevent Stillbirths By 2025, Sachiyo Yoshida, José Martines, Peter Gisore, Joy E. Lawn, Stephen Wall, Joăo Paulo Souza

Paediatrics and Child Health, East Africa

Background: In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025.

Methods: We used adapted Child …

Validity Of Intracerebral Haemorrhge Score In Predicting Prognosis Of Hemorrhagic Stroke, Muhammad Aslam Rind, Muzaffar Sheikh, Manzoor Ali Lakhair, Maria Nazir, Sadia Sheikh

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a common neurological disorder, leading cause of death and disability worldwide. Intra cerebral hemorrhage comprises of 10-15% of all strokes but associated with high risk of morbidity and mortality than cerebral infraction .The ICH Score is a good prognostic tool calculated very easily, when it is used to predict 30 day morality. Objective:To determine the validity of Intracerebral hemorrhagic score in predicting prognosis (adverse outcome or death) in patients of hemorrhagic stroke.Material&Methods:This case series study was carried out at department of medicine Liaquat medical University Hospital Jamshoro and Hyderabad from June 16th 2012 to December 15th 2012.Eighty nine …

Demographic Profile And Associations Of Dialysis Dependent Chronic Kidney Disease Patients In Federal Capital Of Pakistan., Ali Zohair Nomani, Mansoor Iqbal, Faisal Bacha, Shahzad Mughal, Haris Majid Rajput, Mazhar Badshah, Rao Suhail Yasin Khan

Pakistan Journal of Neurological Sciences (PJNS)

Depression is quite prevalent in patients with chronic kidney disease. Knowing the frequency of depression in such patients and its association with different variables may be helpful in devising strategies for better and timely management of such patients in our setup. Materials and methods: This cross sectional study was conducted by recruiting 315 patients of either gender, ≥ 18 years of age with chronic kidney disease (CKD) and receiving care at Pakistan Institute of Medical Sciences, Islamabad. Patients were divided into two groups; group A: pre-dialysis and group B: dialysis (End Stage Renal Disease). Prevalence of depression in CKD and …

Lung Functions Among Patients With Pulmonary Tuberculosis In Dar Es Salaam – A Cross-Sectional Study, Mohamed Manji, Grace Shayo, Simon Mamuya, Rose Mpembeni, Ahmed Jusabani, Ferdinand Mugusi

Faculty of Health Sciences, East Africa

Background

Approximately 40–60 % of patients remain sufferers of sequela of obstructive, restrictive or mixed patterns of lung disease despite treatment for pulmonary tuberculosis (PTB). The prevalence of these abnormalities in Tanzania remains unknown.

Methods

A descriptive cross-sectional study was carried out among 501 patients with PTB who had completed at least 20 weeks of treatment. These underwent spirometry and their lung functions were classified as normal or abnormal (obstructive, restrictive or mixed). Logistic regression models were used to explore factors associated with abnormal lung functions.

Results

Abnormal lung functions were present in 371 (74 %) patients. There were …

Primary Anaplastic Pleomorphic Xanthoastrocytoma In Adults. Case Report And Review Of Literature, Usama Khalid Choudry, Saad Akhtar Khan, Amjad Qureshi, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Pleomorphic xanthoastrocytoma (PXA) classified as a low Grade (WHO II) astrocytic neoplasm. It is known for its relatively favorable prognosis. It most commonly occurs in young adults. Malignant progression in PXA has been frequently reported since its first description in 1979; however, the presentation of a primary anaplastic PXA tumor with an aggressive clinical course in adults is rare especially in the later age group.
Case description: We present a case of primary anaplastic PXA in a 53 year old male that manifested with an early recurrence pattern at 9 weeks. Treatment performed was surgical excision and external beam …

Cerebral Venous Sinus Thrombosis With Tentorial Haemorrhagic Infarctions In Combined Proteins Deficiency And Hyperhomocysteinemia Treated With Anticoagulation- Limited Evidence With Good Results: A Case Report, Muhammad Waqas, Muhammad Akbar Baig, Shahan Waheed Aga Khan University, Munawar Khursheed

Department of Emergency Medicine

We are presenting a case of a 40-year-old lady who presented with sudden loss of consciousness. Computed Tomography scan of her brain revealed the presence of blood in her sub-arachnoid space on her right hemisphere, cerebral oedema, and cerebral venous sinus thrombosis later magnetic Resonance Imaging revealed extensive cerebral venous sinuses thrombosis formation associated with supra and infra-tentorial haemorrhages. Elevated levels of plasma homocysteine and deficient levels of protein S. Patient was anticoagulated with warfarin and INR was monitored. She recovered successfully with no complication of anticoagulation observed. The use of anticoagulation had a favourable outcome in our …

Small Bowel Ascaris Infestation: A Diagnostic Challenge, Muhammad Waqas Khan, Sanniya Khan Ghauri

Department of Emergency Medicine

Ascariasis is a common infestation in developing countries where there is poor hygiene. A majority of the cases are asymptomatic, with a few cases presenting with mild abdominal pain and nutritional deficiencies in the long term. Here we present a case of a young boy who presented as a diagnostic dilemma, with signs of acute intestinal obstruction without any supporting radiological evidence. A barium study revealed the presence of low-burden Ascaris infestation that was managed medically.

A Lost Tribe In The City: Health Status And Needs Of African Asylum Seekers And Refugees In Hong Kong, William Chi Wai Wong, Sealing Cheng, Eleanor Holroyd, Julie Chen, Kelley Ann Loper, Lynn Tran, Heidi Yin Hai Miu

School of Nursing & Midwifery, East Africa

Background: Hong Kong’s resistance to be a signatory of the 1951 Geneva Convention and lack of domestic policies in this area has resulted in restrictions on access to healthcare amongst asylum seekers and refugees (ASRs). Using social determinants of health framework this study sought to identify health practices, problems and needs of African ASRs in Hong Kong.

Methods: A cross-sectional survey comprising of six domains including health status, health-seeking behaviour and social experience targeted at adult African ASRs in Hong Kong was conducted through three local non-governmental organisations between February and April 2013. Outpatient care and inpatient care in the …

The Impact And Successes Of A Paediatric Endocrinology Fellowship Program In Africa, Gordon Otieno Odundo, Thomas Ngwiri, Olivia Otuoma, Paul Laigong, Renson Mukhwana, Mary Limbe, Nadia Musimbi Chanzu

Paediatrics and Child Health, East Africa

Background: The prevalence and distribution of endocrine disorders in children in Africa are not well known because most cases are often undiagnosed or diagnosed too late. The awareness of this led to the launch of the Paediatric Endocrinology Training Center for Africa (PETCA) designed to improve quality and access to health care by training paediatricians from Africa in paediatric endocrinology.

Methods: The fellowship is undertaken over an 18-month period: six months of clinical and theoretical training in Kenya, nine months of project research at the fellow’s home country, and three months of consolidation in Kenya. Upon completion, certified paediatricians are …

High Prevalence Of Liver Fibrosis In Patients With Human Immunodeficiency Virus Monoinfection And Human Immunodeficiency Virus Hepatitis-B Co-Infection As Assessed By Shear Wave Elastography: Study At A Teaching Hospital In Kenya, Samuel Gitau, Sudhir Vinayak, Micah Ominde, Rodney Adam, Reena Shah

Imaging & Diagnostic Radiology, East Africa

Objectives:The aim of this study was to determine the prevalence of liver fibrosis in patients with human immunodeficiency virus (HIV) monoinfection versus those with HIV hepatitis-B virus (HBV) co-infection as assessed with shear wave elastography (SWE) in a tertiary sub-Saharan Africa hospital.

Materials and Methods:A total of 105 consecutive patients, 70 with HIV monoinfection and 35 with HIV-HBV co-infection, had liver elastography obtained using SWE to assess for the presence of liver fibrosis the cutoff of which was 5.6 kPa. Assessment of aspartate aminotransferase-to-platelet ratio index (APRI) score (a noninvasive serum biomarker of liver fibrosis) in these patients …

Remission Of Psychosis In Treatment-Resistant Schizophrenia Following A Seizure: A Case Report, Hena Jawaid, Sana Younus, Hanif Mesiya

Department of Psychiatry

The authors report a case of treatment-resistant schizophrenia in a 22-year-old woman, who, despite multiple trials of antipsychotics, did not respond to treatment. Clozapine treatment was initiated, but the patient's symptoms did not remit until after she had a clozapine-induced seizure. The authors discuss the importance in considering that electroconvulsive therapy may be effective in reducing positive and negative symptoms in patients suffering from treatment-resistant schizophrenia.

Comparison Of Clinical Laboratory Standards Institute And European Committee On Antimicrobial Susceptibility Testing Guidelines For The Interpretation Of Antibiotic Susceptibility At A University Teaching Hospital In Nairobi, Kenya: A Cross-Sectional Study, Ali Kassim, Geoffrey Omuse, Zul Premji, Gunturu Revathi

Pathology, East Africa

Background: The Clinical Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines are the most popular breakpoint guidelines used in antimicrobial susceptibility testing worldwide. The EUCAST guidelines are freely available to users while CLSI is available for non-members as a package of three documents for US $500 annually. This is prohibitive for clinical microbiology laboratories in resource poor settings. We set out to compare antibiotic susceptibility determined by the two guidelines to determine whether adoption of EUCAST guidelines would significantly affect our susceptibility patterns.

Methods: We reviewed minimum inhibitory concentrations (MIC) of various antibiotics routinely …