Medical Specialties Commons^™

Acute Flaccid Myelitis Caused By Enterovirus Infection- A Case Report, Ahmad Bilal, Tipu Sultan, Zia Ur Rehman, Arshad Mehmood, Amber Shabir, Javeria Raza

Pakistan Journal of Neurological Sciences (PJNS)

Enterovirus is a member of the Picornaviridae family, an enterovirus. It is suspected of causing a polio-like disorder called acute flaccid myelitis (AFM). This case report aims to present a 10-year-old boy who presented with neurological manifestations of weakness of lower limbs and urinary retention. He had reduced tone, absent reflexes, and palpable bladder. MRI spine revealed inflammation in grey matter of spinal cord. He was treated with high dose steroids and IVIG but no improvement was observed. Enterovirus was isolated from his stool sample. The patient received supportive care and physiotherapy with gradual improvement after months, having no evidence …

Severe Falciparum Malaria In Young Children Is Associated With An Increased Risk Of Post-Discharge Hospitalization: A Prospective Cohort Study, Robert Opoka, Ruth Namazzi, Dibyadyuti Datta, Paul Bangirana, Andrea L. Conroy, Michael J. Goings, Kagan A. Mellencamp, Chandy C. John

Paediatrics and Child Health, East Africa

Background Few studies have described post-discharge morbidity of children with specifc manifestations of severe malaria (SM) beyond severe malarial anaemia or cerebral malaria.

Methods Children 6 months to 4 years of age admitted at Jinja and Mulago hospitals in Uganda, with one or more of the fve most common forms of SM, cerebral malaria (n=53), respiratory distress syndrome (n=108), malaria with complicated seizures (n=160), severe malarial anaemia (n=155) or prostration (n=75), were followed for 12 months after discharge, alongside asymptomatic community children (CC) (n=120) of similar ages recruited from the households or neighbourhoods of the children with SM. Incidence and …

Kinetics Of Naturally Induced Binding And Neutralising Anti-Sars-Cov-2 Antibody Levels And Potencies Among Sars-Cov-2 Infected Kenyans With Diverse Grades Of Covid-19 Severity: An Observational Study, John Kimotho, Yiakon Sein, Shahin Sayed, Reena Shah, Mansoor Saleh, Ann Karanu, Viviane Oluoch, Jasmit Shah, Julius Mutiso, Zaitun Nneka, Alfred Mburu, Peter Betti, Francis M. Ndungu

Pathology, East Africa

Background: Given the low levels of coronavirus disease 2019 (COVID-19) vaccine coverage in sub-Saharan Africa (sSA), despite high levels of natural severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) exposures, strategies for extending the breadth and longevity of naturally acquired immunity are warranted. Designing such strategies will require a good understanding of naturally acquired immunity.

Methods: We measured whole-spike immunoglobulin G (IgG) and spike-receptor binding domain (RBD) total immunoglobulins (Igs) on 585 plasma samples collected longitudinally over five successive time points within six months of COVID-19 diagnosis in 309 COVID-19 patients. We measured antibody-neutralising potency against the wild-type (Wuhan) SARS-CoV-2 …

Exploring Psychotic Symptoms Among Substance-Naïve Individuals And Recent Abstainers Without A Psychosis Diagnosis: A Cross-Country Study Across Kenya, Uganda, Ethiopia, And South Africa, Isaac Babu Kisiang'ani, Mohammed Aden, Henry R. Mwangi, Dickens Akena, Melkam Alemayehu, Julius Barasa, Bizu Gelaye, Stella Gichuru, Lukoye Atwoli, Symon M. Kariuki

Internal Medicine, East Africa

Psychotic symptoms are of increasing interest in mental health due to their predictive value for future psychotic disorders. While these symptoms are prevalent in the general population, their occurrence varies globally. This study aimed to explore the prevalence and factors associated with psychotic symptoms among individuals identified as substance-naïve and recent abstainers without a history of psychosis. A cross-sectional analysis was conducted on 11,686 participants who reported no lifetime substance use, no substance use in the previous three months, and did not have a diagnosis of psychosis. The study utilized the Psychosis Screening Questionnaire to estimate the one-year prevalence of …

Labrad : Vol 49, Issue 2 - December 2024, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• EDITORIAL
• ARTICLES
• Anti-Glomerular Basement Membrane (GBM) Disease: Pathogenesis, Presentation, and Diagnostic Insights
• Advanced Total Laboratory Automation (TLA) Workflow: A Comprehensive Approach towards High-Throughput Analyzers in Clinical Chemistry
• Precision Under Pressure: Challenges in Therapeutic Drug Monitoring for Immunosuppressants
• Frozen Section: Diagnostic Accuracy, Pitfalls and Use of Digital Pathology
• Working Environment Perspective of a Learner
• AI Training: A Must-Have Skill for Tomorrow’s Radiologists
• Challenges in Blood Supply: Importance of Voluntary Donations
• Leadership Skills and Emotional Intelligence For Professional Capacity Building in Histopathology – A Broad Perspective
• Factor VIII and XI Deficiency; A Finding That Could Have Been Missed-A Case Report
• Accelerated Phase …

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer's Disease Detection And Monitoring, Melissa Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah Pape, Juan Fortea, Nicholas Ashton, Chinedu Momoh, Sid O'Bryant

Brain and Mind Institute

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer's Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

Dynamics Of The Blood Plasma Proteome During Hyperacute Hiv-1 Infection, Jamirah Nazziwa, Eva Freyhult, Mun-Gwan Hong, Emil Johansson, Filip Årman, Jonathan Hare, Kamini Gounder, Melinda Rezeli, Tirthankar Mohanty, Amin Hassan

Institute for Human Development, East Africa

The complex dynamics of protein expression in plasma during hyperacute HIV-1 infection and its relation to acute retroviral syndrome, viral control, and disease progression are largely unknown. Here, we quantify 1293 blood plasma proteins from 157 longitudinally linked plasma samples collected before, during, and after hyperacute HIV-1 infection of 54 participants from four sub-Saharan African countries. Six distinct longitudinal expression profiles are identified, of which four demonstrate a consistent decrease in protein levels following HIV-1 infection. Proteins involved in inflammatory responses, immune regulation, and cell motility are significantly altered during the transition from pre-infection to one month post-infection. Specifically, decreased …

Plasma Transfusion In The Intensive Care Unit, Maite M. T. Van Haeren, Senta Jorinde Raasveld, Sanne De Bruin, Merijn C. Reuland, Claudia Van Den Oord, Jimmy Schenk, Cécile Aubron, Jan Bakker, Maurizio Cecconi, Marcus Lance

Anaesthesiology, East Africa

Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design and Methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications.

Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% …

Management Of Adult Sepsis In Resource-Limited Settings: Global Expert Consensus Statements Using A Delphi Method, Louise Thwaites, Prashant Nasa, Brett Abbenbroek, Vu Quoc Dat, Simon Finfer, Arthur Kwizera, Lowell Ling, Suzana M. Lobo, Robert Sinto, Wangari Siika

Anaesthesiology, East Africa

Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resourcelimited settings.

Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacifc Sepsis Alliance (APSA). The committee selected an interna‑ tional panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the fnal consensus statements.

Results: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include …

High Yield Of Congenital Hypothyroidism Among Infants Attending Children Hospital, Nairobi, Kenya. Facility Based Study In The Absence Of Newborn Screening, Menbere Kahssay, Thomas Ngwiri

Paediatrics and Child Health, East Africa

Objectives: Congenital hypothyroidism (CHT) is a treatable cause of intellectual disability. Late diagnosis and delayed initiation of treatment leads to irreversible neurodevelopmental and intellectual disability. Thus, newborn screening is crucial. However, 71 % of babies are born in an area with no established newborn screening program and Kenya is not an exception. We aimed to determine the incidence of CHT, developmental outcomes of patients in the absence of newborn screening.

Methods: A retrospective data of subjects who met the inclusion criteria, newborn and infants from 3 days to 2 years whose thyroid function test (TFT) was undertaken during well baby …

“Breaking Barriers: Empowering African Youth Through Implementation Of A Therapeutic Patient Education Program For Juvenile Idiopathic Arthritis”, Wafa Hamdi, Angela Migowa, Hanene Lassoued Ferjani, Alia Fazaa, Saoussen Miladi, Kaouther Maatallah, Kawther Ben Abdelghani, Ayodele Faleye

Paediatrics and Child Health, East Africa

Introduction: Patient education is crucial in managing chronic diseases like Juvenile Idiopathic Arthritis (JIA). Traditional methods such as videos and brochures often fail to maintain long-term knowledge retention. Therapeutic Patient Education (TPE) offers a more effective, patient-centered approach.

Objective: PAFLAR aimed to implement a TPE program with a “train the trainers” masterclass to ensure effective delivery and improve outcomes for children with JIA.

Methods: PAFLAR’s TPE program was designed through a focus group, involving a literature review and strategic planning for the implementation step. The program includes specialized training for healthcare professionals enhancing their abilities to deliver …

Burden Of Vascular Neurological Disorders: A Cross-Sectional Multicenter Study, Shafaq Saleem, Safia Awan, Ibrar Rafiq, Muhammad Hassan Shaikh, Anjum Farooq, Maimoona Siddiqui, Zainab Aslam Saeed Memon, Alam Ibrahim Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Stroke remains a leading cause of morbidity and mortality worldwide, with a particularly high burden in low- and middle-income countries (LMICs) such as Pakistan. Despite its growing prevalence, limited nationwide data exist on vascular diseases, their risk factors, and disability outcomes. The objective of this study was to identify the frequency and age-stratified type of vascular disease incidence among in-patient hospital admissions.

Methods

A retrospective observational study was conducted across 39 neurology centers in Pakistan, spanning both public and private sectors from August 2017 to December 2019. Data on demographics, comorbidities, and stroke type were systematically collected …

Electrographic Significance Of Periodic Discharges And Association With Etiology And Outcome In A Tertiary Care Hospital: A Retrospective Cohort Study, Hina Imtiaz, Zainab Memon, Ayisha Farooq Khan, Dureshahwar Kanwar, Safia Awan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Periodic discharges on electroencephalograms (EEGs) are rhythmic waveforms that may indicate acute or subacute brain injury. This aim of this study was to determine the frequency distribution of periodic discharge subtypes on EEG and to assess their association with underlying etiologies and clinical outcomes in a tertiary care hospital.

Methods

This retrospective observational cohort study included neurological patients aged ≥18 years admitted to the medical ICU or ward of Aga Khan University Hospital between January 1, 2021, and January 1, 2023, with periodic discharges on EEG. Patients with prior traumatic brain injury were excluded. Data on demographics, …

Epilepsy In Pakistani Adolescents Amid The Vaping Epidemic, Maheen Kalwar, Eisha Tur Raazia, Harmain Naz Shaikh

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

New Onset Seizures Evolving Into Refractory Status Epilepticus In The Setting Of Covid-19: A Case Report, Mahira Mushtaq, Zuha Amin, Shafaq Saleem, Fowzia Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

The novel Coronavirus disease (COVID-19) has been shown to involve the nervous system (both central and peripheral), with or without respiratory involvement in multiple ways. Although not much is known about this disease yet, seizures and status epilepticus which may evolve into refractory status epilepticus have been associated with it along with other manifestations like encephalopathy, neuropathies etc. The mechanism for development of seizures with COVID-19 related disease is not entirely known however it can be the consequence of “cytokine release syndrome” or “cytokine storm” which has been associated with this virus. Patients with COVID-19 infection who develop resistant status …

Pakistan Ischemic Stroke Guidelines, Anjum Farooq, Maria Khan, Ayesha Zafar, Husnain Hashim, Fozan Khan, Abdul Malik, Ayeesha Kamran Kamal Aga Khan University, Karachi, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death and disability. Mortality related to stroke is very high in low- and middle-income countries. Stroke imposes a great socioeconomical burden in Pakistan. It is important to take important steps for prevention and proper management of stroke in country. Purpose of developing stroke guidelines is to improve stroke care in Pakistan. Guidelines are designed to help neurologists and general practitioners for treating stroke. American stroke guidelines, NICE guidelines, Canadian guidelines and multiple important articles including those emphasizing stroke care in low- and middle-income countries were studied, and these current guidelines were designed in …

Ten-Year Review Of St-Segment Elevation Myocardial Infarction (Stemi) In Tanzania: A Single Center Retrospective Review, Nadeem Kassam, Mohamed Varwani, Mzee Ngunga, Jeilan Mohamed, Mangaro Mabusi, James Orwa, Salim Surani, Robert Mvungi, Nasiruddin Jamal

Internal Medicine, East Africa

Introduction: Ischemic Heart Disease (IHD) is an emerging epidemic in sub-Saharan Africa (SSA). Although the true burden may be underreported in the African continent, it still remains one of the leading causes of death among adults aged above 60 years. ST-Segment Elevation Myocardial Infarction (STEMI) is a clinically time-sensitive fatal sequela of IHD with timely reperfusion by primary Percutaneous Coronary Intervention (PCI) being the gold standard of care. There has been steady progress in coronary care services in Tanzania, alongside a rise in IHD-related risk factors. However, data on this is limited. This study aimed to examine trends in …

Quality Of Life After Myocardial Infarction In The Pakistani Population – Insights From A Single-Center Cohort Study, Javerya Hassan, Manzar Abbas, Hajra Arshad, Angelina Jessani, Izza Tahir, Shiza Qazi, Jasmit Shah, Zul Merali, Zainab Samad

Brain and Mind Institute

Background Health-related Quality of life (HRQoL) assessment is essential for optimizing patient care, treatment adjustments, and medical decision-making, particularly in post-Myocardial Infarction (MI) patients, but limited data exists on HRQOL post-MI from Pakistan. This study aimed to assess HRQoL and its determinants in the Pakistani population.

Methods A single-center cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Patients≥18 years old with a primary diagnosis of acute MI (ICD-9 codes: 410.0-410.9 and ICD-10 codes: 121.0- 121.9) discharged from the Cardiology Service from January 2019 to December 2020 who could be contacted and consented to participate were included. …

Focused Ultrasound: A New Era In Tremor Control, Sajid Hameed

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Tocilizumab In The Management Of Neuromyelitis Optica Spectrum Disorder: A Narrative Review Of Literature And Critical Appraisal, Salman Mansoor, Samar Iltaf Mairajuddin, Saqib Gul

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective

Neuromyelitis Optica Spectrum disorder (NMOSD) mostly affects the spinal cord and optic nerves. This manuscript aims to explore the treatment potential of tocilizumab, a monoclonal antibody that targets the interleukin-6 (IL-6) receptor and regulates inflammatory cytokines implicated in the pathophysiology of NMOSD. Methods

A thorough search of the pertinent literature was done for this research utilising electronic databases, specifically PubMed, Cochrane Library, and Embase, which contained studies published from 2016 to 2024.

Results Clinical studies show that tocilizumab improves clinical outcomes and lowers recurrence rates in people with NMOSD, especially those who don't respond to traditional treatments. …

Chorea As A Rare Manifestation Of Neuropsychiatric Systemic Lupus Erythematosus: A Case Report, Qurat Ul Ain, Ashfeen Ishfaq, Farzana Kouser, Rabia Rasool

Pakistan Journal of Neurological Sciences (PJNS)

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multisystemic involvement. It has variable clinical presentations and a relapsing and remitting course. Clinical manifestations are broad, ranging from mild mucocutaneous involvement to major organ involvement. We present a case of a 32-year-old female with repeated movements of the right arm, and confusion with a background of pains in multiple joints. She was diagnosed as a case of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). She was managed with pulse therapy of cyclophosphamide (CYC) along with other supportive medications. After six months of intensive immunosuppressive therapy, she remained well and continued maintenance …

An Evaluation Of The Effectiveness Of An Updated Pre-Service Midwifery Curriculum Integrated With Emergency Obstetric And Newborn Care In Kenya: A Cluster Randomised Controlled Trial, Duncan N. Shikuku, Catherine Mwaura, Peter Nandikove, Alphonce Uyara, Helen Allott, Lucy Waweru, Lucy Nyaga, Edna Tallam, Issak Bashir, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Introduction Quality midwifery education is central to improving midwifery service delivery and maternal and newborn health outcomes. In many settings, midwifery educators insufciently prepared for their teaching role and defcient curriculum compared to international standards afect the quality of healthcare provided by the midwifery graduates. This study assessed the efectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in Kenya.

Methods A cluster randomised controlled trial in 20 midwifery colleges (12 intervention, 8 control colleges). Educators in both arms received training in teaching/EmONC skills to deliver the …

Effectiveness Of Clinical Training In Influencing The Outcome Of Visual Inspection With Acetic Acid In Selected Facilities At A County In Kenya, Evah Maina, Abednego Ongeso, Nancy Maingi

School of Nursing & Midwifery, East Africa

Background: Cervical cancer remains a major health concern in developing countries, primarily due to the presence of human papillomavirus (HPV) types 16 and 18. Visual Inspection with Acetic Acid (VIA) is a common and affordable screening method, yet its effectiveness is closely tied to the skills and competency of healthcare providers. This study aimed to assess the impact of clinical training on improving VIA screening outcomes for cervical cancer in a county in Kenya.

Methods: Seven government health facilities equipped with cryotherapy machines were selected, with two healthcare providers sampled from each. A six-day VIA training intervention was conducted, combining …

Whole Exome-Seq And Rna-Seq Data Reveal Unique Neoantigen Profiles In Kenyan Breast Cancer Patients, Godfrey Wagutu, John Gitau, Kennedy Mwangi, Mary Murithi, Elias Melly, Alexandra R. Harris, Shahin Sayed, Stefan Ambs, Francis Makokha

Pathology, East Africa

Background: The immune response against tumors relies on distinguishing between self and non-self, the basis of cancer immunotherapy. Neoantigens from somatic mutations are central to many immunotherapeutic strategies and understanding their landscape in breast cancer is crucial for targeted interventions. We aimed to profile neoantigens in Kenyan breast cancer patients using genomic DNA and total RNA from paired tumor and adjacent non-cancerous tissue samples of 23 patients.

Methods: We sequenced the genome-wide exome (WES) and RNA, from which somatic mutations were identified and their expression quantified, respectively. Neoantigen prediction focused on human leukocyte antigens (HLA) crucial to cancer, HLA type …

A Time-Stratified, Case–Crossover Study Of Heat Exposure And Perinatal Mortality From 16 Hospitals In Sub-Saharan Africa, Claudia Hanson, Jeroen De Bont, Kristi Sidney Annerstedt, Maria Del Rosario Alsina, Federica Nobile, Nathalie Roos, Peter Waiswa, Andrea Pembe, Jean-Paul Dossou, Claudia Hanson, Hussein Kidanto

Brain and Mind Institute

Growing evidence suggests that extreme heat events affect both pregnant women and their infants, but few studies are available from sub-Saharan Africa. Using data from 138,015 singleton births in 16 hospitals in Benin, Malawi, Tanzania and Uganda, we investigated the association between extreme heat and early perinatal deaths, including antepartum and intrapartum stillbirths, and deaths within 24 h after birth using a time-stratified case–crossover design. We observed an association between an increase from the 75th to the 99th percentile in mean temperature 1 week (lag 0–6 d) before childbirth and perinatal mortality (odds ratio (OR) = 1.34 (95% confidence interval …

Removing Lead From The Global Economy, Stephen P. Luby, Jenna E. Forsyth, Zafar Fatmi, Mahbubur Rahman, Jesmin Sultana, Erica L. Plambeck, N Grant Miller, Eran Bendavid, Peter J. Winch, Howard Hu

Community Health Sciences

No abstract provided.

Association Of Chronic Malnutrition, And Not Anemia, With Cognitive Development In Ethiopian Schoolchildren: A Cross-Sectional Study, Befikadu Tariku Gutema, Muluken Bekele Sorrie, Sifray Batire, Tadiwos Hailu Zewdie, Bruno Levecke, Amina Abubakar, Stefaan De Henauw, Souheila Abbeddou

Institute for Human Development, East Africa

This study assesses the associations between nutritional statusand cognitive development of schoolchildren. A unit increase inheight-for-age Z-score was associated with 0.12 SD, 0.08 SD and0.12 SD increase in standardized digit span, Raven’s coloredprogressive metrics, and performance index of visual searchtask, respectively. A unit increase in body-mass-index-for-ageZ-score was associated with 0.11 SD increase in standardizeddigit span. Hemoglobin concentration was not associated withany of the cognitive outcomes. Chronic malnutrition was asso-ciated with cognitive development in schoolchildren while thin-ness and hemoglobin concentrations were associated withselected or no cognitive outcomes, respectively.

An Expansion Of The Phenotype In Individuals With Syncrip-Related Neurodevelopmental Disorder, Tooba Shafiq, Joanna Feng, Lindsay Phillips, Kara Murias, Marcia Ferguson, Kristin Baranano, Alaina Acchione, Patricia Kipkemoi, Collins Kipkoech, Amina Abubakar

Institute for Human Development, East Africa

Disruption of genes within the HNRNP gene family has been observed in neurodevelopmental and neurodegenerative diseases. The HNRNP-Related Neurodevelopmental Disorders (HNRNP-RNDDs), while each unique, have been recently described with similar clinical and molecular features across variation in several genes. However, the phenotypic information on these patients is still lacking. In this case series we aim to describe the phenotypes that are associated with SYNCRIP-Related Neurodevelopmental Disorder (SYNCRIP-RNDD). We describe in depth ten novel individuals and one previously published individual with mostly de novo and predicted damaging variants in SYNCRIP, consistent with a diagnosis of SYNCRIP-RNDD. We also describe previously published …

Rectovaginal Fistula Due To Undiagnosed Rectal Tuberculosis In A Nulliparous Young Woman: A Case Report, Daudi Gidion, Brenda Moshi, Gregory Ntiyakunze, James Chapa, Peter Majinge, Munawar Kaguta

Obstetrics and Gynaecology, East Africa

Introduction: Rectovaginal fistulas (RVFs) can arise from various etiologies, the most common cause especially in developing countries is obstetric injury. Uncommonly, rectal tuberculosis can present as RVF, posing a diagnostic and treatment challenge especially in a patient without established risk factors. The first case of rectal tuberculosis was reported by Davis et al., in 1957, and a 2022 systematic review identified only 28 cases reported since then.

Presentation of Case: we report the case of a 25-year-old college woman who presented with a 3-month history of lower abdominal pain and fecal passage per vagina. She had undergone a failed …

Dementia Risk Reduction In The African Context: Multi-National Implementation Of Multimodal Strategies To Promote Healthy Brain Aging In Africa (The Africa-Fingers Project), Chinedu Momoh, Rachel Maina, Lukoye Atwoli, Karen Blackmon, Edna Bosire, Gloria Chemutai, Linda Khakali, Sylvia Mbugua, Zul Merali, Olivera Nesic Taylor,, Anthony Ngugi, Cyprian Mostert, Eunice Muthoni, Roselyter Riang’A, Mansoor Saleh, Shahin Sayed, Jasmit Shah

Brain and Mind Institute

Dementia prevention in Africa is critically underexplored, despite the continent's high prevalence of modifiable risk factors. With a predominantly young and middle-aged population, Africa presents a prime opportunity to implement evidence-based strategies that could significantly reduce future dementia cases and mitigate its economic impact. The multinational Africa-FINGERS program offers an innovative solution, pioneering culturally sensitive, multidomain interventions tailored to the unique challenges of the region. Leveraging insights from landmark global studies such as Worldwide-FINGERS and Alzheimer's Disease Neuroimaging Initiative, the program employs a multideterminant precision prevention framework, grounded in community based systems dynamics. Africa-FINGERS further integrates cutting-edge state-of-the-art multimodal biomarker …