Medical Specialties Commons^™

Representation Of South Asian Countries In Five High-Impact Anesthesia Journals, Mohammad Irfan Akhtar, Karima Karam Khan, F. Khan

Department of Anaesthesia

Context: The South Asian region is comprised of eight countries, i.e., Pakistan, India, Bangladesh, Sri Lanka, Afghanistan, Bhutan, Nepal, and Maldives. There is dearth of literature documenting anesthesia research in this region.
Aim: The aim of this audit was to look at research productivity in the region by examining the volume and the type of anesthesia publication in five high-index anesthesia journals.
Settings and Design: The study design was a survey of literature in the top five high-impact anesthesiology journals carried out at a tertiary care hospital.
Materials and Methods: The journal citation report 2016 was accessed to identify the …

Hidradenocarcinoma: Five Years Of Local And Systemic Control Of A Rare Sweat Gland Neoplasm With Nodal Metastasis, Benazir Mir, Muhammad Atif Mansha, Nasir Ali, Ahmed Nadeem Abbasi, Syed Mustajab Ahmed, Bilal Mazhar Qureshi

Department of Radiation Oncology

Hidradenocarcinoma is a rare and locally aggressive tumor rendering a poor prognosis. Furthermore, very few cases present with nodal metastasis. Diagnosing such an entity, and then differentiating it from a benign counterpart, poses a great challenge to the clinicians. There are no established treatment guidelines for the management of this disease, particularly in patients with nodal involvement. We present a case of a young male who was diagnosed with hidradenocarcinoma of the scalp, along with a neck swelling. A thorough diagnostic evaluation was done with endoscopy, pathological, and radiological investigations. He was successfully treated with resection of the scalp lesion …

Subacute Sclerosing Panencephalitis – Current Perspectives, Sidra K. Jafri, Raman Kumar, Shahnaz H. Ibrahim

Department of Paediatrics and Child Health

Subacute sclerosing panencephalitis is a progressive neurodegenerative disease. It usually occurs 7–10 years after measles infection. The clinical course is characterized by progressive cognitive decline and behavior changes followed by focal or generalized seizures as well as myoclonus, ataxia, visual disturbance, and later vegetative state, eventually leading to death. It is diagnosed on the basis of Dyken’s criteria. There is no known cure for subacute sclerosing panencephalitis to date, but it is preventable by ensuring that an effective vaccine program for measles is made compulsory for all children younger than 5 years in endemic countries.

Global Distribution Of Invasive Serotype 35d Streptococcus Pneumoniae Isolates Following Introduction Of 13-Valent Pneumococcal Conjugate Vaccine, Stephanie W. Lo, Rebecca A. Gladstone, Andries J. Van Tonder, Paulina A. Hawkins, Brenda Kwambana Adams, Jennifer E. Cornick, Shabir A. Madhi, Susan A. Nzenze, Mignon Du Plessis, Rama Kandasamy, Philip E. Carter, Sadia Shakoor

Department of Pathology and Laboratory Medicine

A newly recognized pneumococcal serotype 35D, which differs from the 35B polysaccharide in structure and serology by not binding to factor serum 35a, was recently reported. The genetic basis for this distinctive serology is due to the presence of an inactivating mutation in wciG, which encodes an O-acetyltransferase responsible for O-acetylation of a galactofuranose. Here, we assessed the genomic data of a worldwide pneumococcal collection to identify serotype 35D isolates and understand their geographical distribution, genetic background and invasiveness potential. Of 21,980 pneumococcal isolates, 444 were originally typed as serotype 35B by PneumoCaT. Analysis of wciGrevealed 23 isolates …

Availability And Use Of Magnesium Sulphate At Health Care Facilities In Two Selected Districts Of North Karnataka, India, Geetanjali Katageri, Umesh Charantimath, Anjali Joshi, Marianne Vidler, Umesh Ramadurg, Sumedha Sharma, Sheshidhar Bannale, Beth A. Payne, Sangamesh Rakaraddi, Rahat Qureshi

Department of Obstetrics & Gynaecology

Background: Pre-eclampsia and eclampsia are major causes of maternal morbidity and mortality. Magnesium sulphate is accepted as the anticonvulsant of choice in these conditions and is present on the WHO essential medicines list and the Indian National List of Essential Medicines, 2015. Despite this, magnesium sulphate is not widely used in India for pre-eclampsia and eclampsia. In addition to other factors, lack of availability may be a reason for sub-optimal usage. This study was undertaken to assess the availability and use of magnesium sulphate at public and private health care facilities in two districts of North Karnataka, India. Methods: A …

The Feasibility Of Task-Sharing The Identification, Emergency Treatment, And Referral For Women With Pre-Eclampsia By Community Health Workers In India, Umesh Charanthimath, Marianne Vidler, Geetanjali Katageri, Umesh Ramadurg, Chandrashekhar Karadiguddi, Avinash Kavi, Anjali Joshi, Geetanjali Mungarwadi, Rahat Qureshi, Zulfiqar Ahmed Bhutta

Department of Obstetrics & Gynaecology

Background: Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.
Methods: This study was conducted in two districts of Karnataka state in …

Glioblastoma Multiforme Involving Conus Medullaris In A Child, Muhammad Atif Mansha, Agha Muhammad Hammad Khan, Ahmed Nadeem Abbasi, Mohammad Usman Ali, Naureen Mushtaq, Maria Tariq, Asmara Waheed

Department of Radiation Oncology

Primary spinal cord glioblastoma multiforme involving the conus medullaris is an uncommon entity with poor outcomes. An aggressive multimodality treatment approach has been used, but prognosis remains same. There are no guidelines for the treatment of patients with spinal glioblastoma multiforme (GBM). We highlight the case of a child diagnosed with conal GBM. He was treated with definitive surgery followed by adjuvant concurrent chemoradiation. After completion of treatment, he showed a temporary symptomatic improvement, but later on his condition deteriorated. We elaborate the stepwise treatment approach employed in this patient.

Effect Of A Voice Recognition System On Pediatric Outpatient Medication Errors At A Tertiary Healthcare Facility In Kenya, Angela Migowa, William Macharia, Pauline Samia, John Tole, Alfred K. Keter

Paediatrics and Child Health, East Africa

Background: Medication-related errors account for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths. The risk is threefold greater in the pediatric population. In sub-Saharan Africa, research on medication-related errors has been obscured by other health priorities and poor recognition of harm attributable to such errors. Our primary objective was to assess the effect of introduction of a voice recognition system (VRS) on the prevalence of medication errors. The secondary objective was to describe characteristics of observed medication errors and determine acceptability of VRS by clinical service providers.

Methods: This was a before–after intervention study …

Cardiovascular Outcomes Reported In Hemodialysis Trials, Emma O'Lone, Andrea K. Viecelli, Jonathan C. Craig, Allison Tong, Benedicte Sautenet, David Roy, William G. Herrington, Charles A. Herzog, Tazeen Jafar, Meg Jardine

Section of Nephrology

Patients on long-term hemodialysis are at very high risk for cardiovascular disease but are usually excluded from clinical trials conducted in the general population or in at-risk populations. There are no universally agreed cardiovascular outcomes for trials conducted specifically in the hemodialysis population. In this review, we highlight that trials reporting cardiovascular outcomes in hemodialysis patients are usually of short duration (median 3 to 6 months) and are small (59% of trials have <100 participants). Overall, the cardiovascular outcomes are very heterogeneous and may not reflect outcomes that are meaningful to patients and clinicians in supporting decision making, as they are often surrogates of uncertain clinical importance. Composite outcomes used in different trials rarely share the same components. In a field in which a single trial is often insufficiently powered to fully assess the clinical and economic impact of interventions, differences in outcome reporting across trials make the task of meta-analysis and interpretation of all the available evidence challenging. Core outcome sets are now being established across many specialties in health care to prevent these problems. Through the global Standardized Outcomes in Nephrology-Hemodialysis initiative, cardiovascular disease was identified as a critically important core domain to be reported in all trials in hemodialysis. Informed by the current state of reporting of cardiovascular outcomes, a core outcome measure for cardiovascular disease is currently being established with involvement of patients, caregivers, and health professionals. Consistent reporting of cardiovascular outcomes that are critically important to hemodialysis patients and clinicians will strengthen the evidence base to inform care in this very high-risk population.

Slaying Little Dragons: The Impact Of The Guinea Worm Eradication Program On Dracunculiasis Disability Averted From 1990 To 2016, Elizabeth A. Cromwell, Sharon Roy, Dieudonne P. Sankara, Adam Weiss, Jeffrey Stanaway, Ellen Goldberg, David M. Pigott, Heidi Larson, Stein Emil Vollset, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: The objective of this study was to document the worldwide decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD.
Methods: The incidence of GWD was modeled for each endemic country using annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate …

Inherited Bleeding Disorders-Experience Of A Not-For-Profit Organization In Pakistan, Shabneez Hussain, Shahida Baloch, Azra Parvin, Akbar Najmuddin, Farhana Musheer, Mubashra Junaid, Rab Nawaz Memon, Fareeda Bhanbhro, Hayat Ullah, Bushra Moiz

Department of Pathology and Laboratory Medicine

Patient registry is a powerful tool for planning health care and setting groundwork for research. This survey reports a detailed registry of inherited bleeding disorders (IBD) and their management at a not-for-profit organization in a developing country to form the basis for planning development and research. We reviewed medical records of patients with IBD from 8 hemophilia treatment centers of Fatimid Foundation located in various cities. Information collected included sociodemographic data, diagnostic tests, severity of hemophilia A and B, number of bleeding episodes per year, site and frequency of hemarthrosis, and seropositivity for viral diseases. We analyzed 1497 patients from …

Evaluation Of Breast Cancer Biomarkers Using Genexpert® On Core Biopsy-A Retrospective Laboratory Based Validation Study., Erick Chesori

Master of Medicine in Anatomic Pathology

Introduction: Breast cancer is the most common malignancy in women worldwide. It is a significant cause of cancer related morbidity and mortality among Kenyan women. Evaluation of Estrogen receptor (ER), Progesterone receptor (PR), and Human epidermal growth factor receptor 2 (HER2) in breast cancer tissue is standard of care as these biomarkers have been shown to have both prognostic and predictive utility. Immunohistochemistry (IHC) is the gold standard for evaluation of ER/PR/HER2, but its availability in Kenya is limited due to the high operational cost. There have been recent developments in alternative cheaper and readily accessible molecular based testing platforms …

Resistome Of Carbapenem- And Colistin-Resistant Klebsiella Pneumoniae Clinical Isolates, Sara Lomonaco, Matthew A. Crawford, Christine Lascols, Ruth E. Timme, Kevin Anderson, David R. Hodge, Debra J. Fisher, Segaran P. Pillai, Stephen A. Morse, Erum Khan

Department of Pathology and Laboratory Medicine

The emergence and dissemination of carbapenemases, bacterial enzymes able to inactivate most β-lactam antibiotics, in Enterobacteriaceae is of increasing concern. The concurrent spread of resistance against colistin, an antibiotic of last resort, further compounds this challenge further. Whole-genome sequencing (WGS) can play a significant role in the rapid and accurate detection/characterization of existing and emergent resistance determinants, an essential aspect of public health surveillance and response activities to combat the spread of antimicrobial resistant bacteria. In the current study, WGS data was used to characterize the genomic content of antimicrobial resistance genes, including those encoding carbapenemases, in 10 multidrug-resistant Klebsiella …

The Causes And Effects Of Attrition From Post-Graduate Residency Programs At The Aga Khan University Hospital, Nairobi., Dennis Wamalwa

Master of Medicine in General Surgery

Background: Resident attrition is a global problem affecting most postgraduate residency training programs. It not only disrupts the educational and workload balance in the program but also results in loss of valuable time invested by the resident who has to leave before completion. AKUHN has similarly been affected with a worrying increase in resident attrition numbers over the last few years. There is however a lack of local studies on resident attrition which would inform measures to address modifiable risk factors for resident attrition and thus prevent future attrition. Objectives: To explore factors attributable to attrition amongst residents in Aga …

Complete Blood Count Reference Intervals From A Healthy Adult Urban Population In Kenya, Geoffrey Omuse, Daniel Maina, Jane Mwangi, Caroline Wambua, Kiran Radia, Alice Kanyua, Elizabeth Kagotho, Mariza Hoffman, Peter Ojwang, Zul Premji, Kiyoshi Ichihara, Rajiv Erasmus

Pathology, East Africa

Background: There are racial, ethnic and geographical differences in complete blood count (CBC) reference intervals (RIs) and therefore it is necessary to establish RIs that are population specific. Several studies have been carried out in Africa to derive CBC RIs but many were not conducted with the rigor recommended for RI studies hence limiting the adoption and generalizability of the results.

Method: By use of a Beckman Coulter ACT 5 DIFF CP analyser, we measured CBC parameters in samples collected from 528 healthy black African volunteers in a largely urban population. The latent abnormal values exclusion (LAVE) method was used …

The H Syndrome: A Genodermatosis, Sohaib Bhatti, Asma Jamil, Samrah Hasan Siddiqui, Uzair Yaqoob, Luqman Naseer Virk, Areesh Bhatti

Medical College Documents

H syndrome (histiocytosis lymph adenopathy plus syndrome) is an autosomal recessive disorder caused by mutations in the SLC29A3 gene, encoding the human equilibrative nucleoside transporter (hENT3), characterized by cutaneous hyperpigmentation and hypertrichosis, hepatosplenomegaly, hearing loss, heart anomalies, hypogonadism, low height, hyperglycemia/insulin-dependent diabetes mellitus, and hallux valgus/flexion contractures. Exophthalmos, malabsorption, renal anomalies, flexion contractions of interphalangeal joints and hallux valgus, and lytic bone lesions, as well as osteosclerosis, are also seen. If these are lacking, the constellation of additional findings should raise suspicion for H syndrome. As most of the patients reported to date with H syndrome are from traditional, low-income …

Prevalence Of Overweight And Obesity Based On The Body Mass Index; A Cross-Sectional Study In Alkharj, Saudi Arabia, Sameer Al-Ghamdi, Mamdouh M. Shubair, Abdulrahman Aldiab, Jamaan M. Al-Zahrani, Khaled K. Aldossari, Mowafa Househ, Shanila Nooruddin, Hira Abdul Razzak, Ashraf El-Metwally

Department of Paediatrics and Child Health

Background: Obesity and overweight are accompanied with several different chronic diseases. Overweight and obesity can be measured by using body mass index (BMI) and is also used widely as an index of relative adiposity among any population. The aim of the study is to evaluate the prevalence of overweight and obesity among general population in Al-Kharj, Saudi Arabia.
Methods: Cross-sectional analysis was undertaken from a representative sample (N = 1019) of the Al Kharj population. Anthropometric measurements including the waist circumference (in centimeters), height (in meters), and weight (in kilograms) of the subjects were undertaken by means of standard apparatus. …

Recurrent Cns Haemangioblastomas With New Onset Of Retinal Angiomas In A Female Patient Diagnosed As Von Hippel Lindau Syndrome, Javerya Sattar, Ateeq Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

Von hippellindau(VHL) disease being a rare genetic disorder, presents with broad spectrum of clinical manifestation and multiorgan neoplasms. The diagnostic criteria for VHL disease include (i) one central nervous system haemangioblastoma and visceral manifestation , (ii) more than one central nervous system haemangioblastomas and (iii) known family history of VHL disease and any of the visceral manifestation. We report a case of 35 years-female patient who presented with recurrent cerebellar and spinal haemangioblastomas with new onset of retinal angioma,hepatichaemangioma and pancreatic cyst, with previous history of surgical resection of cerebellar and spinal cord lesions. This report highlights the importance of …

Unicameral Bone Cysts: Current Concepts, Shahryar Noordin, Salim Allana, Masood Umer, Mujahid Jamil, Kiran Hilal, Nasir Ud Din

Section of Orthopaedic Surgery

Unicameral bone cysts (UBC) or simple/solitary bone cysts are benign fluid filled cavities that enlarge over time, resulting in thinning of the bone. Usually these cysts are reported in the metaphyseal areas of long bones with open physes. 85% of UBCs occur almost exclusively in children and adolescents. UBCs are more aggressive in the first decade of life and correspondingly the recurrence rate for these patients is four times that for adolescents. The proximal humerus and femur account for almost 90% of these cases. UBCs are classified as active when they are within 1 cm of the physis and latent …

Prevalence And Factors Associated With Female Sexual Dysfunction Amongst Women Using Hormonal And Non-Hormonal Contraception At The Aga Khan University Hospital Nairobi Clinics, Momin Butt

Master of Medicine in Family Medicine

Background: Female sexual function is a complex phenomenon. It integrates all the body systems and is influenced by a variety of factors. Contraceptives have been shown to have variable effects on female sexual function, but there have not been adequately powered studies on this in our setting. Justification: The prevalence of female sexual dysfunction (FSD) has been shown to vary among different population subsets globally. The associations of different factors with FSD have also shown variable conclusions that are not generalizable to our setting. In Kenya there is a high discontinuation rate of contraception and this is mainly attributed to …

Congenitally Corrected Transposition Of The Great Arteries In A Septuagenarian From The Developing Country Of Pakistan, Hunaina Shahab, Salima Ashiqali, Mehnaz Atiq

Section of Pulmonary & Critical Care

Congenitally corrected transposition of the great arteries (CCTGA) is a rare congenital cardiac defect with atrioventricular and ventriculoarterial discordance which leads to heart failure and limits patients' lifespan. We report the case of a 70-year-old lady, from a poor province in Pakistan, who presented for the first time with palpitations and was diagnosed to have CCTGA. She had moderate pulmonic valve stenosis which was protective against heart failure. She had six children all born via spontaneous vertex delivery in her local village. This case exemplifies the fact that pulmonic stenosis is favourable for patients with CCTGA. In a country where …

Creutzfeldt-Jakob Disease: A Case Report Presenting To The Emergency Department, Muhammad Akbar Baig, Sadaf Sheikh

Pakistan Journal of Neurological Sciences (PJNS)

Creutzfeldt-Jakob disease is lethal and most common spongiform encephalopathy worldwide and is rarely encountered in the Emergency department. For the benefit of patients and healthcare workers, rapid consideration of this condition needs to be sought in the setting of rapid neurological decline and myoclonic jerky movements. We present a case of a 54-year old male with behavioral changes, jerky body movements, cognitive dysfunction and left sided weakness developing over the course of few months and presented to our Emergency Department for the evaluation for stroke. Due to the non-specific nature of psychiatric and neurologic complaints, the initial diagnosis remained unclear. …

Frequency Of Vitamin D Deficiency In Multiple Sclerosis Patients: A Cross Sectional Study., Samar Iltaf Pechuho, Alam Ibrahim Siddiqui, Sajjad Husain Jalbani, Safia Sultana, Samina Shaikh, Nagina Shaikh, Fahim Soomro, Mukesh Kumar, Abdul Rehman, Tariq Qazi, Shoaib Soomro, Rizwan Shaikh, Ghulam Mustafa Tunio, Abdul Qayoom Memon

Pakistan Journal of Neurological Sciences (PJNS)

Vitamin D deficiency is linked to poor treatment response in patients with Multiple S clerosis. The aim of this study is to define the frequency of Vitamin D deficiency for early detection and timely intervention leading to improved morbidity rates.

What Influences Family Planning In Rural Pakistan: Franchised Service Provider And Community Health Worker Perspective, Waqas Hameed, Junaid-Ur-Rehman Siddiqui, Muhammad Ishaque, Sharmeen Hussain, Xaher Gul, Hina Najmi, Shehla Noorani, Ghulam Mustafa, Asma Balal

Community Health Sciences

Background: Pakistan has a low modern contraceptive prevalence rate, 26%, leading family planning (FP) programmes to explore partnerships with local private providers to improve access to quality FP services. This study aims to understand the socio-cultural and organizational factors that influence delivery of quality family planning services.
Methods: This qualitative study was conducted with private service providers and community health workers (CHW) in Marie Stopes Society's (MSS) social franchise network. A total of 31 providers and 28 CHWs from Sindh, Punjab, and Khyber Pakhtunkhwa provinces of Pakistan were purposively selected for in-depth interviews. The study used thematic content analysis to …

An Uncommon And Elusive Cause Of Cerebral Venous Thrombosis, Farheen Niazi, Saadia Riaz

Pakistan Journal of Neurological Sciences (PJNS)

We present a case of of young 27year male who was admitted with history of headache and vomiting for one week. He was diagnosed as having dural sinus thrombosis of superior sagittal, right lateral, right sigmoid sinus. There was previous history of uveitis 6 months prior to it. All thrombophilia workup was negative except homocysteine levels were moderately high. He was also found to be having recurring genital and oral ulcers. Pathergy test was negative. His HLA B 51/5 testing came back positive. Final diagnosis of Bechet’s disease was made and responded well to long term steroids and Colchicine. A …

Metachronous Renal Ewing Sarcoma/Primitive Neuroectodermal Tumour In A Survivor Of Burkitt Lymphoma, Kumail Khandwala, Kiran Hilal, Zehra Fadoo, Khurram Minhas

Department of Radiology

We present a case of a 14-year-old girl who was diagnosed with Burkitt lymphoma in 2014. She was managed with chemotherapy and remained in remission for 3 years. On her surveillance imaging in 2017, a left-sided renal neoplastic mass was incidentally discovered. She underwent nephrectomy and pathology of the resected specimen revealed small cell tumour of the kidney with features favouring renal Ewing sarcoma/primitive neuroectodermal tumour. Molecular genetic analysis by fluorescence in situ hybridisation was performed which showed translocation of 22q12, thereby confirming the diagnosis. This is a rare secondary malignancy and an unusual association. This case highlights the importance …

One Pulmonary Lesion, 2 Synchronous Malignancies, Masooma Aqeel, Nevin Uysal Biggs, Timothy S. Fenske, Nagarjun Rao

Section of Cardiology

Introduction. Mantle cell lymphoma (MCL) comprises approximately 3% to 10% of all non-Hodgkin lymphomas. Although there is an increased risk for secondary malignancies after treatment among non-Hodgkin lymphomas survivors, a synchronous diagnosis of primary lung cancer arising in conjunction with lymphoma at the same site has rarely been reported. We report an unusual case of primary lung adenocarcinoma with coexistent MCL within the same lung lesion. Case Presentation. A 55-year-old female with newly diagnosed stage IV-B MCL was referred for workup of a right upper lobe cavitary lesion detected during lymphoma staging. A whole-body positron-emission tomography-computed tomography scan …

Association Of Tissue Vitamin D Receptor Expression With Breast Cancer Molecular Subtypes In Kenyan Women, Mutambuki Kimondo

Master of Medicine in Anatomic Pathology

Background: Previous studies have shown that reduced vitamin D receptor expression in breast cancer tissue is associated with worse disease outcomes. Furthermore, studies show that estrogen negative and triple negative breast cancer is associated with a poor prognosis and a low breast tissue vitamin D receptor (VDR) expression. Other studies also report that low serum vitamin D levels are associated with more aggressive breast cancer. Methods: This was a cross-sectional study with both a retrospective and a prospective arm. The retrospective part was nested within a larger study; previously constructed tissue microarray blocks (TMA) blocks were used for analysis of …

Environmental Enteropathy In Undernourished Pakistani Children: Clinical And Histomorphometric Analyses, Sana Syed, Sunil Yeruva, Jeremy Herrmann, Anne Sailer, Kamran Sadiq, Najeeha Talat Iqbal, Furqan Kabir, Kumail Ahmed, Shahida Qureshi, Syed Asad Ali

Department of Paediatrics and Child Health

Despite nutrition interventions, stunting thought to be secondary to underlying environmental enteropathy (EE) remains pervasive among infants residing in resource-poor countries and remains poorly characterized. From a birth cohort of 380 children, 65 malnourished infants received 12 weeks of nutritional supplementation with ready-to-use therapeutic food (RUTF). Eleven children with insufficient response to RUTF underwent upper endoscopy with duodenal biopsies, which were compared with U.S., age-matched specimens for healthy, celiac disease, non-celiac villous atrophy, non-celiac intraepithelial lymphocytosis, and graft-versus-host disease patients. Of the 11 children biopsied, EE was found in 10 (91%) with one subject with celiac disease. Morphometry demonstrated decreased …

Genetic Sequencing For Surveillance Of Drug Resistance In Tuberculosis In Highly Endemic Countries: A Multi-Country Population-Based Surveillance Study, Matteo Zignol Md, Andrea Maurizio Cabibbe, Anna S. Dean, Philippe Glaziou, Natavan Alikhanova, Cecilia Ama, Sönke Andres, Anna Barbova, Rumina Hasan, Zahra Hasan

Department of Pathology and Laboratory Medicine

Background: In many countries, regular monitoring of the emergence of resistance to anti-tuberculosis drugs is hampered by the limitations of phenotypic testing for drug susceptibility. We therefore evaluated the use of genetic sequencing for surveillance of drugresistance in tuberculosis.
Methods: Population-level surveys were done in hospitals and clinics in seven countries (Azerbaijan, Bangladesh, Belarus, Pakistan, Philippines, South Africa, and Ukraine) to evaluate the use of genetic sequencing to estimate the resistance of Mycobacterium tuberculosisisolates to rifampicin, isoniazid, ofloxacin, moxifloxacin, pyrazinamide, kanamycin, amikacin, and capreomycin. For each drug, we assessed the accuracy of genetic sequencing by a comparison of the adjusted …