Medical Specialties Commons^™

Post Covid-19 Vaccine Guillain Barre Syndrome, Soban Khan, Maryam Khalil, Zaid Waqar, Sajid Khan, Zakir Jan

Pakistan Journal of Neurological Sciences (PJNS)

The Guillain Barre Syndrome (GBS) is an acute immune-mediated progressive polyneuropathy having an acute monophasic illness leading to paralysis. The clinical features are progressive ascending symmetrical muscle weakness that may lead to respiratory failure. Diagnosis is based upon clinical presentation and is supported by a lumbar puncture with CSF analysis demonstrating albumin-cytological dissociation, and electrophysiological studies. Our patient presented to us with progressive ascending paralysis after receiving COVID 19 vaccine.

Succinic Semialdehyde Dehydrogenase Deficiency – A Rare Cause Of Metabolic Stroke, Areeba Wasim, Javeria Raza Alvi, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Succinic semialdehyde dehydrogenase (SSADH) deficiency is a rare neurometabolic disorder characterized by defective degradation of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter of the brain. Children with SSADH deficiency present with motor and mental delay, intractable seizures, infantile onset hypotonia, speech disturbances, extrapyramidal symptoms and ataxia. This wide spectrum results from increased accumulation of 4hydroxy butyric acid (4HBA) leading to down regulation of GABA receptors, which likely explain epileptogenesis but the pathophysiology of stroke in SSADH deficiency is not much elucidated. Here, we report an infant aged 11 months, product of consanguineous marriage with significant family history of motor delay …

Risk Factors Of Intracerebral Hemorrhage – A Cross Sectional Study, Mir Jalal-Ud-Din, Raheel Jehangir Jadoon, Syed Affan Ali, Samia Wazir Khawaja, Zahid Gul Jadoon, Ibtisam .

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and Objective: Stroke is the major cause of disability and one of the top causes of death in the globe. Though the rate is decreasing in the West, it is most likely growing in Asia. In Pakistan, the burden of stroke risk factors is substantial. Although data on the incidence and prevalence of stroke in Pakistan is limited, there are several published case studies demonstrating major disparities in stroke epidemiology, risk factors, kinds, and patterns. This study aims to identify risk factors of intracerebral hemorrhage among patients presenting to a teaching hospital. Methods: From August 2019 to February …

Iranian Stroke Model-How To Involve Health Policymakers, Mehdi Farhoudi, Ehsan Sharifipour

Pakistan Journal of Neurological Sciences (PJNS)

Stroke in Iran, with more than 83 million population, is a leading cause of disability and mortality in adults. Stroke has higher incidence in Iran comparing the global situation and unfortunately the onset age of first ever stroke is dropping about 10 years.1 Intravenous thrombolysis, as an approved treatment in ischemic stroke, has been used only in some university or private hospitals in Iran since 2008.2 The main limit for this therapy in Iran was the lack of coverage by health insurance companies for tPA. A project for situation analysis of stroke cases entering to Imam Reza Hospital, a tertiary …

Urban Family Planning In Sub-Saharan Africa: An Illustration Of The Cross-Sectoral Challenges Of Urban Health, Trudy Harpham, Moses Tetui, Robert Smith, Ferdinand Okwaro, Adriana Biney, Judith Helzner, James Duminy, Susan Parnell, John Ganle

Obstetrics and Gynaecology, East Africa

The multi-sectoral nature of urban health is a particular challenge, which urban family planning in sub-Saharan Africa illustrates well. Rapid urbanisation, mainly due to natural population increase in cities rather than rural–urban migration, coincides with a large unmet urban need for contraception, especially in informal settlements. These two phenomena mean urban family planning merits more attention. To what extent are the family planning and urban development sectors working together on this? Policy document analysis and stakeholder interviews from both the family planning and urban development sectors, across eight sub-Saharan African countries, show how cross-sectoral barriers can stymie efforts but also …

Fetal Movement Trials: Where Is The Evidence In Settings With A High Burden Of Stillbirths?, Natasha Housseine, Joyce Browne, Nanna Maaløe, Brenda Sequeira Dmello, Sam Ali, Muzdalfat Abeid, Tarek Meguid, Marcus J. Rijken, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

No abstract provided.

Provision Of Labour Analgesia And Its Related Barriers Among Maternal Health Care Providers In Kenya: An Institution-Based Descriptive Survey., Gabriel Ouma, Elkanah Omenge, Edwin Were, Kimbley Omwodo

Obstetrics and Gynaecology, East Africa

Background: Although pain relief is a key component of modern obstetric care, it remains a poorly established service in sub-Saharan countries, such as Kenya. Maternal health care providers have an extensive role to play in meeting the analgesic needs of women, during childbirth. This study sought to examine the practice of labour pain relief and its deterrents among Kenyan maternal health care providers.

Methods: This was an institution based, cross-sectional, descriptive survey. The study population included midwives, obstetricians, and anaesthesiologists working at the second largest tertiary facility in Kenya. A structured, self- administered questionnaire was used. The patterns …

Comparison Of Two Immunoassays For Detection Of Anti-Sars Cov-2 Antibodies Among Healthcare Workers At A Tertiary Referral Hospital In Nairobi, Kenya, Patrick Muriuki Mugaine

Master of Medicine in Clinical Pathology

Background: Tests for antibodies against severe acute respiratory syndrome coronavirus 2, the aetiologic agent of coronavirus disease 2019, provide evidence of past infection or immunization. At the individual level, they are useful as markers of protection against severe disease and in cases where the diagnosis by nucleic acid amplification is inconclusive. At the population level, they are an indirect measure of exposure and may be useful in monitoring changes in viral infection or uptake of immunization over time. The interpretation and optimal use of antibody assays on populations requires an appreciation of the wide variability in individual antibody responses, the …

Single Oral Or Single Intramuscular Dose Of Vitamin D In The Treatment Of Vitamin D Deficiency In Children At Aga Khan University Hospital, Nairobi: A Randomized Controlled Trial, Winfred Mwikali Ndaka

Master of Medicine in Paediatrics and Child Health

Background: Vitamin D deficiency is a global health concern and plays an important role in bone health and many chronic non-communicable diseases. Vitamin D deficiency in children is associated with short stature, underdevelopment, respiratory infections and many other features that increase the risk of childhood complications. The prevalence of vitamin D deficiency in Kenya among children is high. Treatment with daily oral vitamin D is associated with poor compliance. While a single high intramuscular dose vitamin D offers an alternative strategy, it is however, associated with injection site pain and its absorption is dependent on the patient’s peripheral circulation. Various …

The 5th Edition Of The World Health Organization Classification Of Haematolymphoid Tumours: Lymphoid Neoplasms, Rita Alaggio, Catalina Amador, Ioannis Anagnostopoulos, Ayoma D. Attygalle, Iguaracyra Barreto De Oliveira Araujo, Emilio Berti, Govind Bhagat, Anita Maria Borges, Daniel Boyer, Shahin Sayed

Pathology, East Africa

We herein present an overview of the upcoming 5th edition of the World Health Organization Classification of Haematolymphoid Tumours focussing on lymphoid neoplasms. Myeloid and histiocytic neoplasms will be presented in a separate accompanying article. Besides listing the entities of the classification, we highlight and explain changes from the revised 4th edition. These include reorganization of entities by a hierarchical system as is adopted throughout the 5th edition of the WHO classification of tumours of all organ systems, modification of nomenclature for some entities, revision of diagnostic criteria or subtypes, deletion of certain entities, and introduction of new entities, as …

Group B Streptococcus Infection During Pregnancy And Infancy: Estimates Of Regional And Global Burden, Bronner P. Gonçalves, Simon R. Procte, Proma Paul, Jaya Chandna, Alexandra Lewin, Farah Seedat, Artemis Koukounari, Ziyaad Dangor, Shannon Leahy, Amina Abubakar

Institute for Human Development, East Africa

Background: Group B streptococcus (GBS) colonisation during pregnancy can lead to invasive GBS disease (iGBS) in infants, including meningitis or sepsis, with a high mortality risk. Other outcomes include stillbirths, maternal infections, and prematurity. There are data gaps, notably regarding neurodevelopmental impairment (NDI), especially after iGBS sepsis, which have limited previous global estimates. In this study, we aimed to address this gap using newly available multicountry datasets.

Methods: We collated and meta-analysed summary data, primarily identified in a series of systematic reviews published in 2017 but also from recent studies on NDI and stillbirths, using Bayesian hierarchical models, and …

Cardiovascular Risk Factors And Markers Of Myocardial Injury And Inflammation In People Living With Hiv In Nairobi, Kenya: A Pilot Cross-Sectional Study, Hassan Adan Ahmed, Jeilan Mohamed, Isaiah G. Akuku, Kuan Ken Lee, Shirjel R. Alam, Pablo Perel, Jasmit Shah, Mohammed K. Ali, Sherry Eskander, Michael H. Chung

Internal Medicine, East Africa

Objectives: To determine the prevalence of cardiovascular disease (CVD) risk factors and explore associations with high-sensitivity cardiac troponin I (hscTnI) and high-sensitivity C-reactive protein (hsCRP) in people living with HIV (PLHIV) in Kenya.

Design: Pilot cross-sectional study.

Setting: Data were collected from community HIV clinics across two sites in Nairobi, Kenya, from July 2019 to May 2020.

Participants: Convenience sample of 200 PLHIV (≥30 years with no prior history of CVD).

Outcome measures: Prevalence of cardiovascular risk factors and its association with hsTnI and hsCRP levels.

Results: Across 200 PLHIV (median age 46 years, IQR 38–53; 61% women), the …

Protocol For A Sequential, Prospective Meta-Analysis To Describe Coronavirus Disease 2019 (Covid-19) In The Pregnancy And Postpartum Periods, Emily R. Smith, Erin Oakley, Siran He, Rebecca Zavala, Kacey Ferguson, Gargi Wable Grandner, Ibukun-Oluwa Omolade Abejirinde, Yalda Afshar, Homa Ahmadzia, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to …

Integrated Multilayer Omics Reveals The Genomic, Proteomic, And Metabolic Influences Of Histidyl Dipeptides On The Heart, Keqiang Yan, Zhanlong Mei, Jingjing Zhao, Md Aminul Islam Prodhan, Detlef Obal, Kartik Katragadda, Benjamin Doelling, David Hoetker, Dheeraj Kumar Posa

Internal Medicine, East Africa

Background: Histidyl dipeptides such as carnosine are present in a micromolar to millimolar range in mammalian hearts. These dipeptides facilitate glycolysis by proton buffering. They form conjugates with reactive aldehydes, such as acrolein, and attenuate myocardial ischemia-reperfusion injury. Although these dipeptides exhibit multifunctional properties, a composite understanding of their role in the myocardium is lacking.

Methods and Results: To identify histidyl dipeptide-mediated responses in the heart, we used an integrated triomics approach, which involved genome-wide RNA sequencing, global proteomics, and unbiased metabolomics to identify the effects of cardiospecific transgenic overexpression of the carnosine synthesizing enzyme, carnosine synthase (Carns), in …

Perceived Barriers To Peritoneal Dialysis Among Kenyan Nephrologists: A Cross-Sectional Descriptive Study, Saleem Abdul Karim Sokwala, John Otieno Odhiambo, Ahmed Sokwala

Internal Medicine, East Africa

Background: Peritoneal dialysis (PD) is a well-recognized technique of renal replacement therapy (RRT), with similar efficacy as well as survival outcomes as hemodialysis (HD). Despite its advantages including prolonged preservation of residual renal function, potentially lower cost and advances with automated techniques, and commercialization of more biocompatible solutions, the overall prevalence of patients treated with PD is still very low in developed countries and even more so in Africa and low-middle income countries like Kenya. According to our knowledge, no local studies have been done on prevalence of peritoneal dialysis or on potential barriers to utilization of PD as an …

Evaluation Of The Nasopalatine Canal (Npc) In A Subset Of Pakistani Population, Using Cone Beam Computed Tomography (Cbct), Madiha Khan, Saqib Habib, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objective: To evaluate variations in the shape, diameter, length and width of the nasopalatine canal along with the width of the buccal cortical bone anterior to it, using cone beam computed tomography imaging.
Methods: The retrospective, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September to October 2020, and comprised pre-existing cone beam computed tomography scans taken between 2015 and 2020 of patients of either gender aged 18-60 years who had maxillary central incisors present. The shapes and dimensions of the nasopalatine canal were observed along with the buccal bone anterior to the nasopalatine canal. …

Effect Of Bovine Lactoferrin On Seroconversion Following Polio Vaccine Administration In Children: Protocol For A Double-Blinded Randomised Controlled Trial, Atif Habib, Sidrah Nausheen, Shanila Nooruddin, Tooba Javed, Tariq Samejo, Amjad Hussain, Suneeta Namdave, Sehrish Amirali, Muhammad Umer, Lumaan Sheikh

Department of Paediatrics and Child Health

Introduction: The oral polio vaccine (OPV) has substantial results in eliminating wild poliovirus and the vaccine of choice in polio eradication. However, the mucosal immunity induced by the OPV is still uncertain. Literature has shown that bovine lactoferrin (BLF) is a safe and useful protein found in cow's milk with extraordinary antimicrobial, antiviral, antiinflammatory and immune-modulatory functions that help children's gut to fight against micro-organisms like poliovirus. However, limited data exist regarding the effect of BLF on polio vaccine immune response. The primary objective is to evaluate the effect of BLF in enhancing mucosal and humoral immunity in children following …

Financial Toxicity Tumor Board: A Multi-Disciplinary Team Activity Required In Low And Middle-Income Countries (Lmic), Ahmed Nadeem Abbasi, Sohail Rasool, Laraib Khan

Department of Radiation Oncology

No abstract provided.

Burden, Clinical Characteristics, Risk Factors, And Seasonality Of Adenovirus 40/41 Diarrhea In Children In Eight Low-Resource Settings, Godfrey Guga, Sarah Elwood, Caroline Kimathi, Gagandeep Kang, Margaret N. Kosek, Aldo A M Lima, Pascal O. Bessong, Amidou Samie, Najeeha Talat Iqbal, Zulfiqar Ahmed Bhutta

Department of Biological & Biomedical Sciences

Background: The application of molecular diagnostics has identified enteric group adenovirus serotypes 40 and 41 as important causes of diarrhea in children. However, many aspects of the epidemiology of adenovirus 40/41 diarrhea have not been described.
Methods: We used data from the 8-site Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project birth cohort study to describe site- and age-specific incidence, risk factors, clinical characteristics, and seasonality.
Results: The incidence of adenovirus 40/41 diarrhea was substantially higher by quantitative polymerase chain reaction than enzyme immunoassay and peaked at ∼30 episodes …

Medical Students In Karachi And Covid-19: Myths And Facts, Omer Bin Khalid Jamil, Muhammad Muhib, Muhammad Anas Abbal, Amna Muhammed Ahmed, Hafsa Hayat Khan, Nabeela Yar Khan

Department of Surgery Docs

Objectives: COVID-19 pandemic brought mortalities, morbidities, fear, and financial despair among people around the world. As it advanced, misinformation and myths about it caught wildfire, contributing to misbelief among the already shocked population. Medical students are the building blocks of the medical community and can provide a pivotal role in combating COVID-19 misinformation by delivering correct knowledge and awareness to the non-medical population of the country. Hence, it is important to assess their knowledge and perception of COVID-19 myths. Therefore, this study evaluates medical student's knowledge regarding myths and misinformation related to COVID-19 infection and its vaccine. The study also …

Sex Differences In The Association Between Cardiovascular Diseases And Dementia Subtypes: A Prospective Analysis Of 464,616 Uk Biobank Participants, Caiyun Dong, Chunmiao Zhou, Chunying Fu, Wenting Hao, Akihiko Ozaki, Nipun Shrestha, Salim S. Virani, Shiva Raj Mishra, Dongshan Zhu

Office of the Provost

Background: Whether the association of cardiovascular diseases (CVDs) with dementia differs by sex remains unclear, and the role of socioeconomic, lifestyle, genetic, and medical factors in their association is unknown.
Methods: We used data from the UK Biobank, a population-based cohort study of 502,649 individuals. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between CVD (coronary heart diseases (CHD), stroke, and heart failure) and incident dementia (all-cause dementia, Alzheimer's Disease (AD), and vascular dementia (VD)). The moderator roles of socioeconomic (education, income), …

Facilitators And Barriers To Implementing A Community Rotation To The Internship Training In Kenya, Peter Mwanza Kioko

Master of Medicine in Family Medicine

Background: Primary care is increasingly being prioritized all over the world more so in developing countries in an effort geared towards achieving health equity. The availability of skilled human resources at the community level has been shown to improve health outcomes. However, doctor numbers remain low in sub-Saharan countries. Kenya’s policy on universal health coverage aims to enable access to essential health services by all its citizens by 2022. The introduction of community placements among undergraduate medical students has proven beneficial in understanding community health problems, the role of primary care in health as well as increasing the likelihood of …

Burden In Family Caregivers Of Patients With Chronic Mental Illness In Aga Khan University Hospital And Mathari National Referral Hospital, Nairobi, Kenya., Norah Atieno Obungu

Master of Medicine in Family Medicine

Introduction: In Africa, about 60% of patients with chronic mental health disorders live with their relatives. Family caregivers bear the responsibility of managing relatives with mental illness in the home environment, and this may result in psychopathology in the caregivers. Although extensively studied in the Western world, not much is known about the caregiver burden in Kenya. Objectives: The primary objective of the study was to find out the prevalence of caregiver burden among family caregivers of patients with chronic mental illness attending two psychiatric care facilities in Nairobi. The secondary objective was to determine the socio-demographic characteristics and correlates …

What Motivates The Choice Of Specialty Among Medical Doctors In Tanzania, Thabit Ramadhani

Master of Surgery

Background: Studies have shown there is a low specialist workforce, coupled with wide range of disparity among different specialities in the country to cater for the needs of more than 54 million Tanzanians. The theories of motivation and development have shown many theories influencing choices made by people in life. Objectives: This study aims to assess the motivation for choice of specialty among medical doctors (including registrars, residents, and specialists) in Dar es Salaam, Tanzania. Methods: A descriptive cross-sectional study was conducted at Muhimbili University of Health and Allied Sciences, Muhimbili National hospital, and the Aga Khan University Hospital Dar …

Validation Of The Kiswahili Version Of The Migraine Disability Assessment Scale In Dar Es Salaam, Tanzania, Aliasger Nagri

Master of Internal Medicine

Background: Migraine is a chronic paroxysmal neurological disorder characterized by multiphase attacks of head pain and many neurological symptoms. The MIDAS is a five (5) question-based questionnaire used in clinical practices to identify the disability caused by migraine at work, school, household or social life; with a score indicating little or no disability (0-5), mild disability (6-10), moderate disability (11-20), and severe disability (21+). Translated versions of the MIDAS scale in a number of languages has been validated. Translating and validating the Kiswahili version of the MIDAS questionnaire is essential and needed to ensure its comparability to the original English …

The Quality Of Primary Care Performance In Private Sector Facilities In Nairobi, Kenya: A Cross-Sectional Descriptive Survey, Gulnaz Mohamoud, Robert Mash

Family Medicine, East Africa

Background: Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of informa- tion on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya.

Methods: A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context …

Renal Angina Index As A Predictor Of Acute Kidney Injury In Critically Ill Children, Athul Shelly Kooliyath

Master of Medicine in Paediatrics and Child Health

Background: Acute kidney injury is associated with increased morbidity and mortality in hospitalized children. In the critically ill,DR WILLIAM M MACHARIA acute kidney injury (AKI) is prevalent and difficult to diagnose. Using conventional methods, AKI is often missed thus delaying the diagnosis up to 48 hours after initial injury. Though some biomarkers that identify AKI early have been identified, they may still be insufficient due to prohibitive costs. Renal angina index is used to identify ongoing renal injury. It is a product of the clinical state and the estimated glomerular filtration rate (eGFR) of a patient during admission to a …

Feasibiity And Acceptability Of Tele-Neurology Services At A Regional Tertiary Referral Centre: A Prospective Study., Fazal Yakub

Master of Medicine in Internal Medicine

Background: Neurological diseases are a leading cause of morbidity and mortality worldwide with a great burden lying in Sub-Saharan Africa. The paucity of neurologists in the region makes neurological care disproportionately inaccessible. Utility of tele-medicine is low cost, time efficient, convenient, reducing the carbon footprint and ultimately increasing health care access. Objective: We identified whether the concept of tele-neurology was feasible within our setup for patients with stable neurological diseases while establishing the cost effectiveness, efficiency, convenience and the carbon footprint burden. Methods: We conducted a prospective cross-sectional study. New patients were triaged by the neurologist based on guidelines from …

Hiv Among Cancer Patients: Prevalence And Cancer Description By Hiv Status, Diana Wambui Muturi

Master of Medicine in Internal Medicine

Background: Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with Human Immunodeficiency Virus (PLHIV) leading to an aging population at risk for non-AIDS defining cancers (NADCs) rather than AIDS-defining cancers (ADCs). Identification of HIV-cancer comorbidity through diagnostic HIV testing of patients presenting for cancer care is not offered routinely. The HIV prevalence among cancer patients in Kenya is undefined. In addition, the spectrum of malignancies in PLHIV has not been well characterized outside of ADCs. Objective: Our primary objective was to determine the prevalence of HIV among patients with cancer. Secondary objectives were to determine …

Ilae Classification And Definition Of Epilepsy Syndromes With Onset In Neonates And Infants: Position Statement By The Ilae Task Force On Nosology And Definitions, Sameer M. Zuberi, Elaine Wirrell, Elissa Yozawitz, Jo M. Wilmshurst, Nicola Specchio, Kate Riney, Ronit Pressler, Stephane Auvin, Pauline Samia, Edouard Hirsch

Paediatrics and Child Health, East Africa

The International League Against Epilepsy (ILAE) Task Force on Nosology andDefinitions proposes a classification and definition of epilepsy syndromes in theneonate and infant with seizure onset up to 2 years of age. The incidence of epi-lepsy is high in this age group and epilepsy is frequently associated with significantcomorbidities and mortality. The licensing of syndrome specific antiseizure medi-cations following randomized controlled trials and the development of precision,gene- related therapies are two of the drivers defining the electroclinical pheno-types of syndromes with onset in infancy. The principal aim of this proposal, con-sistent with the 2017 ILAE Classification of the Epilepsies, is …