Medical Specialties Commons^™

Nasopharyngeal Carcinoma In Pregnancy: Management Approach Case Report At Moi Teaching And Referral Hospital, Eldoret-Kenya, Philip Tonui, Elly B. Odongo, Andrew Cheruiyot, Sahara Shurie, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Nasopharyngeal carcinoma is an uncommon tumour, which raises management dilemma in pregnant women. The condition has a considerable effect on the pregnancy outcome, considering the risk of preterm delivery. This paper reports a case of 26 years old Gravida 7 Para 6 admitted at 28 weeks of gestation with epistaxis, hematemesis and a neck mass. The head CT scan showed a right paranasal space soft tissue mass with bony destruction and bilateral cervical adenopathy, consistent with neoplastic carcinoma. Histopathological examination confirmed the diagnosis of nasopharyngeal carcinoma. Deterioration of the patient’s condition, necessitated emergency caesarean delivery at 32 weeks to accommodate …

Impact Of Peer Review In The Radiation Treatment Planning Process: Experience Of A Tertiary Care University Hospital In Pakistan, Bilal Mazhar Qureshi, Muhammad Atif Mansha, Muneeb Uddin Karim, Asim Hafiz, Nasir Ali, Benazir Mir, Fatima Shaukat, Maria Tariq, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Purpose: To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week.
Materials and Methods: Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. …

Spectrum Of Neurological Disorders In Neurology Outpatients Clinics In Urban And Rural Sindh, Pakistan: A Cross Sectional Study, Safia Awan, Alam Ibrahim Siddiqi, Ahmed Asif, Naveeduddin Ahmed, Hazim Brohi, Sajad Jalban, Mohammad Wasay

Section of Neurology

Background: Neurological disorders are the most common cause of morbidity and mortality in developing countries. Available evidence on urban–rural differences on neurological diseases is scare in such countries. Our study objective was to determine the prevalence of neurological diseases in urban and rural tertiary care hospitals of Sindh, Pakistan.

Methods: This was a cross sectional study conducted in selected urban and rural region of tertiary care hospitals of Sindh, Pakistan. The outpatients medical records of adults (18 years and above) was obtained from January 1st, 2014 to December 31st, 2014.

Results: A total of 10,786 outpatients visit were recorded in …

Early Life Child Micronutrient Status, Maternal Reasoning, And A Nurturing Household Environment Have Persistent Influences On Child Cognitive Development At Age 5 Years: Results From Mal-Ed, Benjamin J J. Mccormick, Stephanie A. Richard, Laura E. Caulfield, Laura L. Pendergast, Jessica C. Seidman, Beena Koshy, Reeba Roshan, Rita Shrestha, Erling Svensen, Muneera Rasheed

Department of Paediatrics and Child Health

Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown.
Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y.
Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured …

Microbial Colonization Of Pneumatic Tourniquets In The Orthopedic Operating Room, Syed Hamza Mufarrih, Nada Qaisar Qureshi, Rizwan Haroon Rashid, Bilal Ahmed, Seema Irfan, Akbar Jaleel Zubair, Shahryar Noordin

Section of Orthopaedic Surgery

Background: The rate of surgical site infections following orthopedic procedures is approximately 2% globally. Potential sources of contamination in the operating room include pneumatic tourniquets, blood pressure cuffs, and stethoscopes, among others. Our study aims to investigate microbial colonization on reusable pneumatic tourniquets stored and used in the orthopedic department of our institution and evaluate the efficacy of the cleaning protocols employed. Methods: Over a course of two weeks, 26 samples were obtained. A total of 14 pneumatic tourniquets were sampled preoperatively on Monday morning following the weekly cleaning protocol of soaking the tourniquets in sodium hypochlorite for 30 minutes …

Beyond Sequencing: Re-Visiting Annotations For Pjl As A Test Case, Waqasuddin Khan, Aisha Ghani, Muhammad Bilal Azmi, Safina Abdul Razzak

Department of Paediatrics and Child Health

Objectives: Current developments in sequencing techniques have enabled rapid and high-throughput generation of sequence data. however, there is a growing gap between the generation of raw sequencing data and the extraction of meaningful biological information. variant annotation is a crucial step in the analysis of genome sequencing data. incorrect or incomplete annotations can cause researchers to dilute interesting variants in a pool of false positives. we require consistent, accurate and reliable annotation of variants for making diagnostic and treatment decisions. current annotation depends on the set of transcripts, and software used can be managed, with sufficient care, in the research …

Emergency Care Surveillance And Emergency Care Registries In Low-Income And Middle-Income Countries: Conceptual Challenges And Future Directions For Research, Hani Mowaf, Christine Ngaruiya, Gerard O'Reilly, Olive Kobusingye, Vikas Kapil, Andres Rubiano, Marcus Ong, Juan Carlos Puyana, Akm Fazlur Rahman, Rashid Jooma, Blythe Beecrof, Junaid Razzak

Section of Neurosurgery

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. …

Advancing Research On Emergency Care Systems In Low-Income And Middle-Income Countries: Ensuring High-Quality Care Delivery Systems, Rachel T. Moresky, Junaid Razzak, Teri Reynolds, Lee A. Wallis, Benjamin Wachira, Mulinda Nyirenda, Waldemar A. Carlo, Janet Lin, Shama Patel, Sanjeev Bhoi, Nicholas Risko, Lily A. Wendle, Emilie J. Calvello Hynes

Emergency Medicine, East Africa

Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on …

Endoscopic Transsphenoidal Surgery For Cushing's Disease: A Review, Mirza Zain Baig, Altaf Ali Laghari, Aneela Darbar, Umme E Hani Abdullah, Sumiya Abbasi

Section of Neurosurgery

Ever since the 1960s, transsphenoidal surgery has been the modality of choice for treating Cushing's disease. Subsequent visualization of the pituitary fossa and sphenoid sinus may be done either with the operating microscope or with the relatively new endoscope. The endoscope due to its panoramic view allows greater visualization as compared to the operating microscope. It confers greater access to the cavernous sinus, sella, suprasellar, and parasellar regions and accommodates higher magnifications. It is bi-dimensional, however as opposed to the operating microscope that provides a three-dimensional view and allows greater depth perception. This article provides a comprehensive review of the …

Characterizing Injury At A Tertiary Referral Hospital In Kenya, Hannah Janeway, Gerard O’Reilly, Florian Schmachtenberg, Nimai Kharva, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: Injury accounts for more than 5.8 million deaths globally with an increasing burden in the developing world. In Kenya, trauma is one of the top 10 leading causes of death. However, no formal continuous injury surveillance systems are in place to inform injury prevention, pre-hospital care or emergency department management. The aim of this study was to implement a hospital-based trauma registry to characterize high acuity injuries presenting to a private tertiary, teaching and referral hospital in Kenya.

Methods: From January to December 2015, data was prospectively collected at a private tertiary, teaching and referral hospital in Nairobi, Kenya. …

Study Of Environmental Enteropathy And Malnutrition (Seem) In Pakistan: Protocols For Biopsy Based Biomarker Discovery And Validation, Najeeha Talat Iqbal, Sana Saeed, Kamran Sadiq, Marium N. Khan, Junaid Iqbal, Jennie Z. Ma, Fayaz Umrani, Sheraz Ahmed, Elizabeth A. Maier, Lee A. Denson, Shahida Qureshi, Syed Asad Ali

Department of Paediatrics and Child Health

Background:
Environmental Enteropathy (EE), characterized by alterations in intestinal structure, function, and immune activation, is believed to be an important contributor to childhood undernutrition and its associated morbidities, including stunting. Half of all global deaths in children < 5 years are attributable to under-nutrition, making the study of EE an area of critical priority.
Methods:
Community based intervention study, divided into two sub-studies, 1) Longitudinal analyses and 2) Biopsy studies for identification of EE features via omics analyses. Birth cohorts in Matiari, Pakistan established: moderately or severely malnourished (weight for height Z score (WHZ) < − 2) children, and well-nourished (WHZ > 0) children. Blood, urine, and fecal samples, for evaluation of potential biomarkers, will be collected at various time points from all participants (longitudinal …

Polyhydramnios Among Women In A Cluster-Randomized Trial Of Ultrasound During Prenatal Care Within Five Low And Low-Middle Income Countries: A Secondary Analysis Of The First Look Study, Melissa Bauserman, Robert Nathan, Adrien Lokangaka, Elizabeth M. Mcclure, Janet Moore, Daniel Ishoso, Antoinette Tshefu, Lester Figueroa, Sarah Saleem, Waseem Mirza

Community Health Sciences

Background: In many low and low-middle income countries, the incidence of polyhydramnios is unknown, in part because ultrasound technology is not routinely used. Our objective was to report the incidence of polyhydramnios in five low and low-middle income countries, to determine maternal characteristics associated with polyhydramnios, and report pregnancy and neonatal outcomes.
Methods: We performed a secondary analysis of the First Look Study, a multi-national, cluster-randomized trial of ultrasound during prenatal care. We evaluated all women enrolled from Guatemala, Pakistan, Zambia, Kenya and the Democratic Republic of Congo (DRC) who received an examination by prenatal ultrasound. We used pairwise site …

Ampa Receptor Glua2 Subunit Defects Are A Cause Of Neurodevelopmental Disorders, Vincenzo Salpietro, Christine L. Dixon, Hui Guo, Oscar D. Bello, Jana Vandrovcova, Stephanie Efthymiou, Reza Maroofian, Gali Heimer, Salman Kirmani, Shahnaz H. Ibrahim

Department of Paediatrics and Child Health

AMPA receptors (AMPARs) are tetrameric ligand-gated channels made up of combinations of GluA1-4 subunits encoded by GRIA1-4 genes. GluA2 has an especially important role because, following post-transcriptional editing at the Q607 site, it renders heteromultimeric AMPARs Ca²⁺-impermeable, with a linear relationship between current and trans-membrane voltage. Here, we report heterozygous de novo GRIA2 mutations in 28 unrelated patients with intellectual disability (ID) and neurodevelopmental abnormalities including autism spectrum disorder (ASD), Rett syndrome-like features, and seizures or developmental epileptic encephalopathy (DEE). In functional expression studies, mutations lead to a decrease in agonist-evoked current mediated by mutant subunits compared to …

Malignant Distal Femur Tumors Management In Children, Low Cost Innovations With Affordable Care In A Tertiary Care Hospital, A Cross Sectional Study, Masood Umer, Javeria Saeed, Obada Hussein Hasan

Section of Orthopaedic Surgery

Introduction: Malignant musculoskeletal tumors in children are mostly comprised of Osteosarcoma and Ewing's sarcoma and distal femur is the most common site for primary bone tumors. This study examined the surgical management outcomes of pediatric patients (<18 years) presented in our setup with malignant distal femur tumors.
Methodology: We retrospectively reviewed the medical records of patients diagnosed with malignant sarcomas of distal femur and younger than 18 years of age who underwent limb salvage surgery during June 2009-June2017.
Results: There were 31 pediatric patients who had distal femur malignant tumors and out of them 20 patients were selected who underwent limb salvage as a primary surgery. The mean age (range) …

Outcome Of Inadvertent High Dose Bcg Administration In Newborns At A Tertiary Care Hospital, Karachi- Case Series, Sonia Qureshi, Khalil Ahmad, Paras Fatima, Rabia M. Hassan, Farheen Sherali, Naureen Lalani, Fyezah Jehan, Syed Asad Ali, Farah Qamar

Department of Paediatrics and Child Health

Bacillus Calmette-Guérin (BCG) vaccine is given to newborns soon after birth. BCG vaccine overdose has been rarely reported. Here we report the outcome of newborns who accidently received high dose BCG at a tertiary care hospital, Karachi. We reviewed records of 26 newborns, who accidentally received intradermal high dose BCG, used for the treatment of urinary bladder cancers and 80 times higher dose than the BCG used for routine vaccination. The incident happened from 14-16th April, 2016 at Aga Khan University Hospital, Karachi. Analysis was carried out using SPSS. A total of 23/26(88.5%) newborns were followed for atleast 3 months …

‘I’M Here To Save My Life’: A Qualitative Study Of Experiences Navigating A Cryotherapy Referral System For Human Papillomavirus-Positive Women In Western Kenya, Megan Huchko, Konyin Adewumi, Sandra Oketch, Ibrahim Saduma, Elizabeth Bukusi

Obstetrics and Gynaecology, East Africa

Background: We sought to understand the beliefs, social norms and logistical factors that affect human papillomavirus (HPV)-positive women’s uptake of cryotherapy treatment as part of a two-part cervical cancer screening strategy in rural Kenya.

Methods: In-depth interviews within a parent cluster-randomised trial.

Setting: Government-run county hospital in western Kenya.

Participants: 273 of 372 (73.4%) HPV-positive women who underwent cryotherapy

Results: Many women feared that an HPV infection meant they would develop cancer. Almost all women reported initial fear of the treatment procedure, followed by a more positive experience than anticipated. Lacking funds for transportation to the treatment site was the …

Provider-Level Variation In Smoking Cessation Assistance Provided In The Cardiology Clinics: Insights From The Ncdr Pinnacle Registry, Mayank Sardana, Yuanyuan Tang, Jared W. Magnani, Ira S. Ockene, Jeroan J. Allison, Suzanne V. Arnold, Phillip G. Jones, Thomas M. Maddox, Salim S. Virani, David D. Mcmanus

Office of the Provost

Background: Studies show suboptimal provision of smoking cessation assistance (counseling or pharmacotherapy) for current smokers attempting to quit. We aimed to identify smoking cessation assistance patterns in US cardiology practices.
Methods and Results: Among 328 749 current smokers seen between January 1, 2013, and March 31, 2016, in 348 NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence)‐affiliated cardiology practices, we measured the rates of cessation assistance. We used multivariable hierarchical logistic regression models to determine provider‐, practice‐, and patient‐level predictors of cessation assistance. We measured provider variation in cessation assistance using median rate ratio (the likelihood that …

Can Alternate-Day Statin Regimen Minimize Its Adverse Effects On Muscle And Tendon?: A Systematic Review, Zehra Abdul Muhammad, Tashfeen Ahmad, Naveed Baloch

Section of Orthopaedic Surgery

Objective: To review evidence-based data with respect to safety and efficacy of alternate-day statin therapy in dyslipidaemia compared to the standard daily dose.
Methods: The literature review was conducted at Aga Khan University Hospital, Karachi from July, 2016 to August, 2017. Electronic database search was carried out to compile available literature using PubMed, Excerpta Medica database and Google Scholar. The most relevant evidence-based research articles published over 10 years were selected. The latest search was dated August 03, 2017.
Results: A total of 2,074 articles were initially located. Alternate day statin regimen was reported in 53% of articles. Adverse effects …

Effect Of Pregnancy On Growth Of Intracranial Meningiomas, Ayesha Quddusi, Muhammad Shahzad Shamim, Quratulain Virani

Section of Neurosurgery

Meningiomas are the most common benign primary intracranial tumours in adults. Their rapid growth during pregnancy has been well reported. Moreover, the relationship of increased progesterone expression during pregnancy and extensive tumour growth has been debated. In this review, we discuss not only the effect of progesterone on meningiomal growth but also other mechanisms involved in gestational meningiomas.

Evaluation Of Kidney Injury Molecule-1 As A Disease Progression Biomarker In Diabetic Nephropathy, Fatima Abid Khan, Syeda Sadia Fatima, Ghulam Mustafa Khan, Sana Shahid

Department of Biological & Biomedical Sciences

Background & Objective: Kidney Injury Molecule-1 (KIM-1) is a peptide whose release into circulation is specific to tubular injury. This study aimed to estimate levels of kidney injury molecule-1 in diabetic patients with and without kidney disease. And evaluate the role of KIM-1 as an early screening marker of progressive kidney injury.
Methods: This follow-up study included n=85 subjects from the diabetic clinic of Jinnah Post Graduate Medical Center (JPMC) in collaboration with Aga Khan University from November 2016 till September 2017. They were divided as: i) Group A1 (n=30) participants with diabetes for <5 years without microalbuminuria ii) Group A2 (n= 30) subjects with diabetes for 6-10 years with microalbuminuria; iii) Group B (n=25) subjects as healthy control group. All study participants were followed for 6 months and their blood glucose, urea, creatinine, electrolytes, albuminuria and serum KIM-1 were assayed.
Results: High KIM-1 at baseline was …

Visual And Treatment Outcomes Of Tubercular Uveitis: A Prospective Case Series From A Referral Hospital In Pakistan, Muhammad Ishaq Ghauri, Nousheen Iqbal, Syeda Urooj Riaz, Muhammad Irfan, Ajeet Kumar, Muhamad Shariq Mukarram

Section of Pulmonary & Critical Care

Objective: Pakistan is the fifth highest TB burden country. Tuberculous uveitis (TbU) is a form of extrapulmonary TB, that is not uncommon in high burden country but very limited data is available on its outcome. The aim of the study is to assess the outcome of TbU with anti-tuberculous treatment (ATT).

Results: A prospective study was conducted at Jinnah Medical College Hospital (JMCH) Karachi, Pakistan from July to December 2017. Patients with suspected TbU were started on standard ATT chemotherapy for 12 months. Their response was assessed via slit lamp examination and visual acuity at 1, 3, 6 and 12 …

Ossification Of The Cruciform Ligament Of Atlas; A Rare Cause Of Cervical Myelopathy: Case Report And Review Of Literature, Muhammad Waqas Saeed Baqai, Gohar Javed, Mirza Zain Baig

Section of Neurosurgery

We present a case of cervical myelopathy secondary to ossification of the cruciform ligament (also known as cruciate ligament). This is a rare phenomenon that, to the best of our knowledge, has only been reported 16 times previously in literature. We have added a review of literature after our case presentation. We hope that by doing so, we may aid clinicians reach early diagnosis so as to be able to better manage this rare disease.

Perianal Necrotizing Fasciitis With Retroperitoneal Extension: A Case Report From Pakistan, Mirza Zain Baig, Abeer Aziz, Umme E Hani Abdullah, Muhammad Salman Khalil, Sumiya Abbasi

Section of Neurosurgery

Necrotizing fasciitis is a rare but potentially fatal condition. It is defined as a rapidly spreading infection of the subcutaneous soft tissue. Extension into the retroperitoneum may further complicate this deadly condition. We report a case of a 45-year-old gentleman who presented to our institute with perianal necrotizing fasciitis with extension into the retroperitoneum. He was managed with antibiotics and prompt surgical debridement. Our patient had a positive outcome which may be due to the fact that we had a high clinical suspicion, on the basis of which we opted for early operative management rather than delaying definitive treatment by …

Clinical Emergency Care Research In Low-Income And Middle-Income Countries: Opportunities And Challenges, Adam R. Aluisio, Shahan Waheed, Peter Cameron, Jermey Hess, Shevin Jacob, Niranjan Kissoon, Adam C. Levine, Asad Mian, Shammi Ramlakhan, Hendry R. Sawe, Junaid Razzak

Department of Emergency Medicine

Disease processes that frequently require emergency care constitute approximately 50% of the total disease burden in low-income and middle-income countries (LMICs). Many LMICs continue to deal with emergencies caused by communicable disease states such as pneumonia, diarrhoea, malaria and meningitis, while also experiencing a marked increase in non-communicable diseases, such as cardiovascular diseases, diabetes mellitus and trauma. For many of these states, emergency care interventions have been developed through research in high-income countries (HICs) and advances in care have been achieved. However, in LMICs, clinical research, especially interventional trials, in emergency care are rare. Furthermore, there exists minimal research on …

A Novel Mutation In The Choroideremia Gene In A Turkish Family., Mustafa Iftikhar, Yulia Wolfson, Simrat Sodhi, Bushra Usmani, Hendrik P. N. Scholl, Syed M.A. Shah

Medical College Documents

Choroideremia is an X-linked recessive genetic disorder caused by mutations in the CHM gene. It is a rare retinal dystrophy that manifests as nyctalopia and vision loss, progressing to blindness in later stages. We report a 21-year Turkish man who presented with nyctalopia for the past 4-5 years. His mother and maternal grandmother had similar, but less pronounced complaints. Fundus examination revealed pigmentary changes and retinal atrophy in both eyes. Optical coherence tomography showed outer retinal loss, with central island of preserved autofluorescence surrounded by absent autofluorescence on fundus autofluorescence examination. Goldmann visual fields were constricted. Microperimetry detected retinal sensitivity …

Labrad : Vol 45, Issue 2 - July 2019, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Novel Molecular Technique for Identifying Respiratory Tract Pathogens
• Role of Serum Galactomannan (GM) Assay in Diagnosing Invasive Aspergillosis (IA)
• Factor VIII Inhibitor – A Diagnostic Approach
• PET/CT Hybrid Imaging Technology at Aga Khan University Hospital
• Diagnostic Tests for Von Willebrand Disease
• Iron Deficiency Anemia
• Sweat Testing for Diagnosis of Cystic Fibrosis
• Flow Cytometric Identification of Abnormal B-Cells
• Direct Immunofluorescence in Bullous Skin Disorders
• Radiology-Pathology Correlation; Orthopedic Pathology
• Fecal Elastase: A Marker For Exocrine Pancreatic Function
• Edward Syndrome: Rare Autosomal Aneuploidy
• Sirolimus in Renal Transplant
• Latest Trends in Clinical Laboratory Science Technology
• Radiology-Neuropathology Correlation
• Nuchal Translucency Scan
• Bio-risk Management System in …

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 …

Position Statement:Emerging Genetic Therapies For Rare Disorders, Pauline Samia, Adam Kirton, Russell Dale, Silvia Tenembaum, Chahnez Charfi Triki, Anaita Hegde, Richard Idro, Jo M. Wilmshurst, Ingrid Tein, Haluk Topaloğlu

Paediatrics and Child Health, East Africa

Emerging genetic therapies for rare disorders at high cost, cannot realistically address the global burden of disease. Stakeholders must develop new pathways to ensure safe, fair and sustainable provision of such therapies.

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 …

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 …