Medical Specialties Commons^™

Analysis Of Candida Auris Fungemia At A Single Facility In Kenya, Rodney Adam, Gunturu Revathi, Nancy Okinda, Melanie Fontaine, Jasmit Shah, Elizabeth Kagotho, Mariana Castanheira, Michael A. Pfaller, Daniel Maina

Pathology, East Africa

Objectives: Candida auris emerged as a human pathogen in 2009 and has subsequently been identified around the world as a cause of invasive candidiasis. We did an analysis from a single institution in order to analyze risk factors and outcomes for C. auris candidemia.

Methods: Patients with candidemia were identified by the electronic medical record and reviewed for risk factors and outcome. Candida isolates were identified by Vitek2 as Candida haemulonii, but species determinations for 21 of the isolates using published molecular and proteomic methods identified all as C. auris.

Findings: From September 2010 to December 2016, C. auris accounted …

Outcomes Of Left Main Percutaneous Coronary Intervention, Nasir Rahman, Bilal Hussain, Azmina Artani

Section of Cardiology

Objective: To study the outcomes of left main percutaneous coronary artery (LMCA) revascularisation.

Study Design: A descriptive study.

Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from February till July 2016.

Methodology: The study included all adult patients aged 18 years or more, who underwent percutaneous LMCA revascularisation at study centre from April 2006 till April 2015. In-hospital outcomes were ascertained of patients via charts along with telephonic follow-up for outcome ascertainment at 1-year and 5-year. Results were expressed in terms of means and standard deviation for quantitative variables and percentages for qualitative variables.

Results: Of …

First Africa Non-Communicable Disease Research Conference 2017: Sharing Evidence And Identifying Research Priorities, Kenneth Juma, Pamela A. Juma, Shukri F. Mohamed, Jared Owuor, Ann Wanyoike, David Mulabi, George Odinya, Maureen Njeru, Gerald Yonga

Imaging & Diagnostic Radiology, East Africa

Non-communicable diseases (NCDs) prevalence is rising fastest in lower income settings, and with more devastating outcomes compared to High Income Countries (HICs). While evidence is consistent on the growing health and economic consequences of NCDs in sub-Saharan Africa (SSA), specific efforts aimed at addressing NCD prevention and control remain less than optimum and country level progress of implementing evidence backed cost-effective NCD prevention approaches such as tobacco taxation and restrictions on marketing of unhealthy food and drinks is slow. Similarly, increasing interest to employ multi-sectoral approaches (MSA) in NCD prevention and policy is impeded by scarce knowledge on the mechanisms …

Urdu Translation And Validation Of The Urogenital Distress Inventory (Udi-6) In Women With Urinary Incontinence, Nuzhat Faruqui, Novera G. Chughtai, Jamil Ahmed

Section of Urology

Objective: To provide an Urdu translation of the six-item version of the Urogenital Distress Inventory (UDI-6) and its validation in patients with urinary incontinence (UI), as the UDI-6 is a recognised, useful disease-specific questionnaire for the evaluation of UI in women.
Patients and Methods: We used a multi-step linguistic translation of the UDI-6, which comprised backward and forward translations coordinated by clinical investigators, followed by a pre-test in 10 patients. The final version was completed by a larger sample of women (n = 200), of which 100 had UI for the last 3 months and 100 had no UI. …

Negative Appendectomy Rate And Associated Factors In Urban Referral Hospitals In Tanzania, Masawa Klint Nyamuryekung’E

Master of Medicine in General Surgery

Background: Acute appendicitis is a common surgical emergency. In atypical presentation, making a clinical diagnosis is difficult leading to delays with high perforation rate or misdiagnoses and high negative appendectomy rates. In the urban referral hospitals in Tanzania the baseline perforation rate, negative appendectomy rate, and factors that drive it are unknown. These could serve as measures of performance, and as evaluation parameters of future interventions aimed at improving acute appendicitis case management in Tanzania. Objectives: The aim of this study was to establish the negative appendectomy rate and associated factors among patients undergoing emergency appendectomy for suspected acute appendicitis …

How Providing Cervical Cancer Screening Results Via Cell Phone Affects Patient Follow-Up Rates In Western Kenya, Megan J. Huchko, Ibrahim Saduma, Cinthia Blat, Sandra Oketch, Elizabeth Bukusi

Obstetrics and Gynaecology, East Africa

Purpose: Human papillomavirus (HPV) testing is being more widely used in simplified cervical cancer screening protocols in low-resource settings. One challenge to successful implementation is the multiple visits necessary to provide results and follow-up. mHealth strategies may reduce visit burden by providing information through text message.

Methods: As part of a cluster-randomized trial to compare HPV testing in clinics and community health campaigns in western Kenya, we carried out a mixed-methods study to assess women's preferences and experiences with different strategies to receive their results. Women could opt to receive their HPV results via text message, cell phone call, home …

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

Master of Medicine in Internal Medicine

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

Chimeric Antigen T Cell Receptor Treatment In Hematological Malignancies, Natasha Ali

Department of Pathology and Laboratory Medicine

No abstract provided.

Participant Perspectives On A Phase I/Ii Ocular Gene Therapy Trial (Nct02077361), Stephanie P. Brooks, Shelly Benjaminy, Tania M. Bubela

Office of the Provost

Background: To learn from the experiences of potential clinical trial participants, participants in a Phase 1 ocular gene therapy trial, and their partners to improve communications and trial conduct.
Materials and methods: Primary and secondary qualitative analysis of semi-structured interviews of potential participants (n = 20), clinical trial participants (n = 2) and their partners (n = 2) in a gene therapy clinical trial for choroideremia (NCT02077361). Analysis included: 1) thematic analysis of transcribed entrance and exit semi-structured interviews with trial participants and their partners; and 2) secondary qualitative analysis of interviews with potential trial participants, …

Vgkc Antibody (Anti Lg1) Associated Limbic Encephalitis In A Young Adult With Full Recovery., Farheen Niazi, Madeeha Iftikhar, Rizwan Ali, Tahir Aziz

Pakistan Journal of Neurological Sciences (PJNS)

A young boy with no premorbids was admitted with fever, fits and psychosis. His initial investigations including cerebrospinal fluid (CSF) routine examination, electroencephalogram(EEG) and MRI brain with contrast were normal. His autoimmune encephalitis panel revealed positive voltage gated potassium channel(VGKC) antibodies, anti -leucine rich glioma inactivated 1 antibody (LG1) group and was give five doses of methylprednisolone and five sessions of plasmapheresis. Psychiatric symptoms took one month to respond. He had a complete recovery. Autoimmune limbic encephalitis should be diagnosed promptly in young patient with fit, psychosis and a high index of suspicion should be kept as initial work up …

Polyneuropathy Associated With Iga Paraproteinemia: A Case Report And Literature Review., Waleed Shahzad, Sumaira Nabi, Hafiza Faiza Mushtaq, Tehmina Inayat, Muhammad Hassan, Haris Majid Rajput, Zakir Jan, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Paraproteinemia is precipitated by an accumulation of monoclonal plasma cells or B lymphocytes. Idiopathic neuropathies that are associated with paraproteinemia account for only 10% of the neuropathies. Paraprotein acts like an antibody and is targeted against myelin and axons present in the peripheral nerves. Despite being of interest for quite a long time, the caudal relationship between paraproteinemias and peripheral neuropathies still remains a sorcery. We report a case of a middle aged male who presented with pain and parasthesias in both arms and legs. His workup revealed him to be having a paraproteinemic neuropathy consistent with IgA Lambda chains …

Is It Really Transverse Myelitis? Acute Flaccid Myelitis A Rare Entity., Hina Yusuf, Arsalan Ahmad, Ejaz Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

Acute Flaccid Myelitis is a relatively new and rare disease entity which was recognized for the first time in United States in 20121. Usually children below 18 years of age present with sudden onset rapidly progressive flaccid paralysis sometimes following upper respiratory tract infection. To date no cases have been reported from Afghanistan and Pakistan. We are reporting case of a young girl who presented with sudden onset flaccid paralysis and respiratory distress. Her MRI Cervical spine showed longitudinally extensive transverse myelitis. One year after the onset of disease flaccid paraparesis continued despite various treatments. It is important to report …

Spectrum Of Electroencephalogram Finding In Children With Newly Diagnosed Epilepsy –An Experience At A Tertiary Care Hospital., Sanam B. Rajper, Khairunnisa Mukhtiar, Fozia Baloch, Shahnaz H. Ibrahim, Abdul Rashid Memon

Pakistan Journal of Neurological Sciences (PJNS)

Epilepsy is the most common neurological disorders that affect all age groups. It is characterized by at least two unprovoked seizures more than 24 hours apart. The most common investigation used for both diagnosis and management is an Electroencephalogram (EEG), which is relatively cheap and easy to perform. However, EEG requires technical expertise and is prone to misinterpretation. Objective: To determine the frequency of abnormal EEG findings in children with newly diagnosed epilepsy at tertiary care hospital.

Humanism And Mental Health Of Married Female Patients With Systemic Lupus Erythematosus., Hafiza Muzammal Shafiq, Dr. Muhammad Rafiq, Dr. Zahid Mahmood

Pakistan Journal of Neurological Sciences (PJNS)

Autoimmune diseases exert adverse impact on the psychological, social and physical well-being of the individuals who suffer from such diseases. Systemic lupus erythematosus is one of chronic illnesses that disturb the all areas of life especially psychosocial perspective of life. In such conditions, belief and view of patients about their own self is necessary to prognosis of their health. Studies suggest that humanism is one of those protective factors that can lead risky health towards better life.

The Mhgap; Will It Bridge The Mental Health Treatment Gap In Pakistan?, Shireen Najam, Aisha Sanober Chachar, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

In Pakistan, the treatment gap for mental disorders is significantly high. Pakistan faces a unique problem of sustainable delivery. In 2009, WHO launched a mental health gap action program (mhGap) to provide evidence-based services at the primary and secondary level for the prevention and management of psychiatric and neurological disorders. This article highlights the discrepancies of the systems and issues related to mental health services provision in Pakistan. By discussing two initiatives of mhGap implementation for the Pakistani health system, authors have surveyed core areas where the sustainability of such a model can be compromised. The structural challenges marked by …

Alterations In Human Reaction Time Upon Consumption Of Taurine-Caffeine Based Energy Drink. A Gender Based Study., Asif Abbasi, Amaila Fazal, Faizan Mirza, Sadaf Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Energy drinks contains several potentially psychoactive ingredients including taurine, glucoronolactone, and caffeine that increases the human performances, reaction time and mood with relative differences to visual and auditory stimuli between both the genders.

Vagal Nerve Stimulation; Current And Future Interventions, Sidra Saleem, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Vagus Nerve is the 10th and the largest cranial nerve of the parasympathetic system, consist of approximately 20% efferent and 80% afferent. It is a big nerve, providing autonomous, cardiovascular, respiratory, gastrointestinal, immune and endocrine systems.

Perception Of Shisha Smoking & Drug Abuse Among University Students Of Karachi, Farwah Rizvi, Lubna Naz, Nazneen Zehra

Pakistan Journal of Neurological Sciences (PJNS)

Tobacco smoking in the form of cigarettes and shisha hasbecome a sign of modernization and trend among youth for pleasant and relaxing experience. Drug addiction is the most common problem in young ones nowadays causing craving practices and long-term consequences includesdisturbances in physical and mental health.

Prevalence Of Risk Factors Promoting Diabetic Neuropathy ., Aisha Qadir, Sumera Sohail1, Lubna Naz, Ghazala Yasmeen, Nazish Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic neuropathy is the worst consequence of diabetes mellitus leading to nerve dysfunction that is the cause of several complications such as pain, loss of sensitivity, damage to body systems, foot ulcers, morbidity and amputations etc. The aim of the present work was to study the prevalence of risk factors and occurrence of diabetic neuropathy in patients with diabetes, and how much diabetic neuropathy complications affect the life of diabetic patients.

Factors Associated With Geriatric Morbidity And Impairment In A Megacity Of Pakistan, Saniya Sabzwari, Romaina Iqbal, Zafar Fatmi, Iqbal Azam Syed

Department of Family Medicine

Background: The elderly population is increasing globally. In Pakistan, the elderly comprise 6% of the population that is predicted to triple by 2050. Non-communicable diseases are common health problems of the elderly in Pakistan, however, resulting geriatric impairments and disability are unknown. This study was conducted to determine geriatric impairments and identify associated socio-demographic factors and comorbidities among community dwelling elderly in Karachi, Pakistan.
Methods: A cross-sectional study was conducted during 2013-2014. Community clusters were selected from all sub-districts of Karachi, the largest city of Pakistan. Data was collected from systematically selected households within these clusters from individuals, aged ≥60 …

Blood Film Says It All! Rare Case Of Congenital Ttp Misdiagnosed As Itp, Ayesha Majeed Memon, Natasha Ali

Department of Pathology and Laboratory Medicine

We report a case of a 16-year-old female who presented with bleeding diathesis. Peripheral blood film examination was consistent with microangiopathic hemolytic anemia with 7% fragmented red blood cells. The ADAMTS13 level was 40 ng/ml (reference range: 630-850 ng/ml). She responded to plasma exchange therapy and methylprednisolone and was discharged in a stable condition.

Mutational Landscape Of Head And Neck Squamous Cell Carcinomas In A South Asian Population, Kulsoom Ghias, Sadiq S. Rehmani, Safina Abdul Razzak, Sarosh Madani, M Kamran Azim, Rashida Ahmed, Mumtaz J Khan

Department of Biological & Biomedical Sciences

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer type globally and contributes significantly to burden of disease in South Asia. In Pakistan, HNSCC is anmong the most commonly diagnosed cancer in males and females. The increasing regional burden of HNSCC along with a unique set of risk factors merited a deeper investigation of the disease at the genomic level. Whole exome sequencing of HNSCC samples and matched normal genomic DNA (n=7) was performed. Significant somatic single nucleotide variants (SNVs) were identified and pathway analysis performed to determine frequently affected signaling pathways. We identified significant, novel …

Pick’S Disease And Subdural Haematoma: A Diagnostic Red Herring, Philip Adebayo, Funmilola Taiwo, Fatma Bakshi, Sunham Nur

Internal Medicine, East Africa

Frontotemporal dementia (FTD), otherwise known as Pick’s disease, is a clinically heterogeneous group of sporadic and familial neurodegenerative diseases. These conditions are characterized by dementia, behavioural and language dysfunction and loss of executive skills resulting from the degeneration of the frontal and temporal lobes. Although reversible causes of dementia are always sought during the evaluation of patients with progressive cognitive decline, the occurrence of a reversible aetiology may distract from evaluating for neurodegenerative causes of dementia. This report is about a 66-year old man with features of FTD and superimposed chronic subdural haematoma.

Drug-Induced Acute-On-Chronic Liver Failure In Asian Patients, Harshad Devarbhavi, Saeed Hamid

Section of Gastroenterology

Objectives: Acute insults from viruses, infections, or alcohol are established causes of decompensation leading to acute-on-chronic liver failure (ACLF). Information regarding drugs as triggers of ACLF is lacking. We examined data regarding drugs producing ACLF and analyzed clinical features, laboratory characteristics, outcome, and predictors of mortality in patients with drug-induced ACLF.

Metods: We identified drugs as precipitants of ACLF among prospective cohort of patients with ACLF from the Asian Pacific Association of Study of Liver (APASL) ACLF Research Consortium (AARC) database. Drugs were considered precipitants after exclusion of known causes together with a temporal association between exposure and decompensation. Outcome …

Ethical Considerations For Conducting Sexual And Reproductive Health Research With Female Adolescents Engaged In High-Risk Behaviours In China, Xu-Dong Zhang, Sabrina Ching Yuen Luk, Yue-Hong Han, Gui-Rong Chen, Bao-Sheng Zhu, Stanley Luchters

Population Health, East Africa

Background: Chinese female adolescents engaged in sex trade and substance use are often criminalized and stigmatized. As a result of these cultural, legal and political constraints, ethical concerns can discourage investigators from engaging these adolescents in research. This paper aims to address the ethical tensions between protection and inclusion in conducting sexual and reproductive health (SRH) research with adolescents engaged in high-risk behaviours. Processes of moral reasoning, and examples and practical mechanisms in managing such ethical challenges were presented in the hope of advancing the research ethics policies and practice with adolescents.

Methods: We extracted ethical issues from three previously …

Safety And Efficacy Of Bendamustine In The Conditioning Regimen For Autologous Stem Cell Transplantation In Patients With Relapsed/Refractory Lymphoma, Munira Moosajee, Samad Jehangir, Sobia Sawani, Tariq Muhammed, N. Ali, Usman Shaikh, Salman Adil

Section of Haematology/Oncology

Background: Bendamustine is an attractive option for the management of both de novo and relapsed lymphomas. It is being increasingly used in the conditioning regimen for autologous stem cell transplantation (SCT) and can be an alternative to the traditionally-used carmustine. In this study, we aimed to determine the safety and efficacy of bendamustine in the conditioning regimen for autologous SCT in refractory/relapsed lymphomas.
Methods: We designed a descriptive study to evaluate bendamustine in combination with etoposide, cytarabine, and melphalan (BeEAM) in the conditioning regimen for autologous SCT.
Results: Fourteen patients (median age, 28 yr) with Hodgkin's lymphoma (HL) (N=8), non-Hodgkin's …

Effect Of Lipid-Based Nutrient Supplement - Medium Quantity On Reduction Of Stunting In Children 6-23 Months Of Age In Sindh, Pakistan: A Cluster Randomized Controlled Trial (Or25-06-19), Sajid Bashir Soofi, Gul Nawaz Khan Nawaz Khan, Cecilia Garzon

Department of Paediatrics and Child Health

Objectives:
We evaluated the effectiveness of a locally produced lipid-based nutrient supplement - medium-quantity (LNS-MQ) known as Wawamum to prevent stunting in children 6–23 months of age in Thatta and Sujawal districts of Sindh province, Pakistan. Methods: A cluster randomized controlled trial was conducted and a total of 870 children between 6–18 months old were enrolled. Children in the intervention group received 50 grams/day of Wawamum for 6 months, while children in the control group received standard government health services, not including Wawamum. The primary outcome was stunting risk reduction among children 6–23 months of age.
Results:
Children who received …

Clinical Screening For Congenital Heart Disease In Newborns At A Tertiary Care Hospital Of A Developing Country, Muhammad Mohsin, Khadija N Humayun, Mehnaz Atiq

Department of Paediatrics and Child Health

Objective:
To screen all newborns admitted to a tertiary care hospital to rule out congenital heart disease before discharge and to find out the utility of pulse oximetry to detect congenital heart disease.
Methodology:
This prospective study was done at Aga Khan University Hospital from January 2014 to December 2014 in 1,650 newborns over a period of 12 months. Pulse oximetry and clinical examination were done. Persistent oxygen saturation less than 95% was considered as positive pulse oximetry. Newborns who had positive pulse oximetry or abnormal clinical examinations findings were subjected to echocardiography.
Result:
Pulse oximetry was performed on 1,650 …

Nurturing Environments And Nutrient-Rich Diets May Improve Cognitive Development: Analysis Of Cognitive Trajectories From Six To Sixty Months From The Mal-Ed Study (Or10-01-19), Benjamin Mccormick, Laura Caulfield, Stephanie Richard, Laura Pendergast, Laura Murray-Kolb, Mal-Ed Network Investigators

Department of Paediatrics and Child Health

Objectives: To identify clusters of cognitive developmental trajectories and associated differentiating factors of children aged 6 to 60 months old in 5 low to middle-income sites.
Methods: We followed 835 children and assessed anthropometry at enrolment (≤ 17 d old); bi-weekly illness data (0–24 and 60 mo); non-diarrheal and diarrheal stools (0–24 mo) analyzed for a panel of enteropathogens; quantitative complementary food intakes (9–24 and 60 mo); micronutrient status (Fe, Zn, Vit A; 7, 15, and 24 mo); quality of the child's home environment (6, 24, and 60 mo) and maternal reasoning ability and depressive symptoms via questionnaire. Child cognitive …

Medical Students: A Reflective Journey Over Time, Saniya Sabzwari, Kulsoom Ghias, Anjiya Sulaiman

Department of Family Medicine

Experiences in medical education have changed significantly in the last two decades. This evolution is apparent in the teaching/ learning environment, types of education resources and learners. In this article two students provide a reflective account of their individual journeys in medical education spanning across 20 years. While some things remain unchanged, significant differences emerge that stress upon the educators and institutions to stay mindful of these transitions in order to develop learning environments that nurture the growth of future physicians.Experiences in medical education have changed significantly in the last two decades. This evolution is apparent in the teaching/ learning …