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Optimal anthropometric discharge criteria from treatment of wasting: meta-analysis of individual patient data from 34 studies
No full textBackground
Community-based treatment of acute malnutrition saves lives, but recovered children remain at risk of relapse post-discharge. Strategies to reduce this risk may include modification of anthropometric discharge criteria. Objectives
This study aims to compare the diagnostic accuracy of anthropometric indices to reduce post-discharge relapse risk. Methods
We searched PubMed from inception to June 2022. We included studies that enrolled children aged 0–59 mo successfully treated for severe or moderate acute malnutrition (SAM or MAM), assessed anthropometry at discharge, and had ≥1 follow-up assessment ≤6 mo post-discharge. Pooled sensitivity and specificity for anthropometric indices at discharge over multiple cutoffs were calculated using a bivariate mixed-effects model. Area under the pooled receiver operating curve (AUC) was estimated to measure diagnostic accuracy. “Pragmatic” cutoffs were defined as those maximizing AUC given both pooled sensitivity and pooled specificity ≥0.75. Primary outcomes were SAM relapse (SAM episode after successful SAM treatment: weight-for-height Z-score (WHZ) \u3c −3, mid-upper arm circumference (MUAC) \u3c 11.5 cm and/or edema) and MAM relapse (MAM episode after successful MAM treatment: −3 ≤ WHZ \u3c −2 or 11.5 cm ≤ MUAC \u3c 12.5 cm). Exposures were WHZ, MUAC, and weight-for-age Z-score (WAZ) at discharge. Results
We included 34 studies from 16 countries contributing 21,989 children. WHZ at discharge had a higher AUC in predicting lower SAM and MAM relapse risk than MUAC or WAZ at discharge. None of the cutoffs examined met the study definition of “pragmatic.” The closest “pragmatic” cutoffs suggested that WHZ cutoffs of −1.4 and −1.8 or MUAC of 12.6 and 12.7 cm had the highest sensitivity and specificity in predicting lower SAM and MAM relapse risk. Conclusions
Relapse risk is high after successful MAM/SAM treatment. Future research can consider optimization of anthropometric discharge criteria as a strategy to reduce post-discharge relapse risk, weighing the operational and financial tradeoffs associated with any modification
Patients´ characteristics and six-month outcomes of patients with atrial fibrillation in Kenya: a retrospective observational cohort study from the National Cardiovascular Registry
No full textIntroduction: atrial fibrillation is increasingly diagnosed in Kenya due to the persistence of rheumatic heart disease and the rising burden of cardiovascular risk factors. We aim to describe the baseline, clinical, treatment characteristics, and six-month outcomes of patients diagnosed with atrial fibrillation in Kenya.
Methods: a retrospective observational cohort study design was employed. Data were obtained from three Kenyan referral hospitals, including public and private institutions. Baseline and six-month data were collected. Depending on the type of variable, data were summarized descriptively.
Results: two hundred forty participants were enrolled, with a median age of 59.0 (IQR: 42.0-75.8). Women made up 54.4% (n=123) of the cohort. The median body mass index was 24.8 kg/m² (IQR: 21.1-29.2), and 62.8% (n=142) of participants were hospitalized at enrollment. Non-valvular atrial fibrillation (AF) was the predominant type, accounting for 77.4% (n=175) of cases, with persistent AF being the most common subtype (60.5%, n=137). At baseline, 77% (n=174) of participants were on anticoagulation therapy. The proportion with high-risk HAS-BLED and CHA2DS2-VASc scores at baseline was 10 (4.4%) and 62 (28.8%), respectively. Hypertension was the most prevalent comorbidity, affecting 39.4% (n=89) of participants. Nearly half (48.6%) had a preserved left ventricular ejection fraction. At the six-month follow-up, all participants remained on anticoagulation therapy. Mortality occurred in 17.7% (n=40) of participants, with cardiovascular causes accounting for 45.0% of these deaths.
Conclusion: the predominant type was non-valvular atrial fibrillation. Enhancing screening for comorbidities and adopting a holistic approach to atrial fibrillation care could lead to better patient outcomes in Kenya
The Aga Khan University Prospectus 2025
No full textMessage from the President Message from the Provost & Vice President, Academic About AKU Our Mission, Vision & Values Why AKU?
Programmes of Study
Undergraduate Programmes School of Nursing and Midwifery, East Africa School of Nursing and Midwifery, Pakistan Medical College, East Africa Medical College, Pakistan Faculty of Arts and Sciences, Pakistan Institute for Educational Development, Pakistan
Graduate Programmes School of Nursing and Midwifery, East Africa School of Nursing and Midwifery, Pakistan Institute for Educational Development, East Africa Institute for Educational Development, Pakistan Medical College, East Africa Medical College, Pakistan Graduate School of Media and Communications, East Africa Institute for the Study of Muslim Civilisations, UK Institute for Human Development
University Services Finance & Financial Assistance Libraries Student Life & Student Experience Accommodation Centre for Innovation in Medical Education Network for English Language Enhancement Networks of Quality, Teaching and Learning AKU Board of Trustees AKU-Kenya University Council & AKU-Uganda University Council Senior Leadershiphttps://ecommons.aku.edu/aku-prospectuses/1011/thumbnail.jp
Procalcitonin-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection in the UK (BATCH): a pragmatic, multicentre, open-label, two-arm, individually randomised, controlled trial
Full text linkBackground Procalcitonin is a rapid response biomarker specific for bacterial infection, which is not routinely used in the UK National Health Service. We aimed to assess whether using a procalcitonin-guided algorithm would safely reduce the duration of antibiotic therapy compared with usual care, in which C-reactive protein is the commonly used biomarker.
Methods The BATCH trial was a pragmatic, multicentre, open-label, parallel, two-arm, individually randomised, controlled trial conducted in 15 hospitals in England and Wales. Children aged 72 h to 18 years who were admitted to hospital and were being treated with intravenous antibiotics for suspected or confirmed bacterial infection and who were expected to remain on intravenous antibiotics for more than 48 h were enrolled. Participants were randomly assigned (1:1) to receive either current clinical management alone (usual care group) or clinical management with the addition of a procalcitonin test guided algorithm (procalcitonin group). Participants were randomly assigned by minimisation, with site and age group (0–6 months, 6 months to 2 years, 2–5 years, and older than 5 years) as minimisation factors and a random element to reduce predictability. Participants were randomly assigned remotely using a secure 24 h web-based randomisation programme. The coprimary outcomes were duration of intravenous antibiotic use, assessed for superiority, and a composite safety measure, assessed for non-inferiority (non-inferiority margin 5%). The primary analysis sample for each coprimary endpoint included all randomly assigned participants with available outcome data. This trial is registered with the International Standard Randomised Controlled Trial Number registry, ISRCTN11369832.
Findings Between June 11, 2018, and Oct 12, 2022, 15 282 children were screened for eligibility, 1949 of whom were randomly assigned to receive procalcitonin-guided antibiotic therapy (n=977) or usual care (n=972). The median intravenous antibiotic duration was 96·0 h (IQR 59·5–155·5) in the procalcitonin group and 99·7 h (61·2–153·8) in the usual care group (hazard ratio 0·96 [95% CI 0·87–1·05]). 78 (9%) of 917 participants in the procalcitonin group and 85 (9%) of 904 participants in the usual care group had at least one event covered by the composite safety outcome measure (estimated adjusted risk difference –0·81% [95% CI upper bound 1·11]).
Interpretation In children with suspected or confirmed bacterial infection admitted to hospitals in England and Wales for intravenous antibiotic treatment of at least 48 h, the introduction of a procalcitonin-guided algorithm did not reduce duration of intravenous antibiotics treatment and is non-inferior to usual care for safety outcomes. Therefore, evidence does not support the use of procalcitonin-guided algorithms where robust effective paediatric antibiotic stewardship programmes are established
Being and becoming third-space professionals: a case study from low-and-middle income countries
Full text linkThis case study explores the authors’ experiences of establishing the identity of third-space professionals at a multi-country university with campuses on three continents. In particular, it draws on their identities and experiences as female leaders in educational development. Using autoethnography, the authors reflect on their experiences to identify issues, strategies, and areas for further development regarding third-space professionals’ identities, particularly with regard to women. As the concept of third-space professionals is relatively new in Low- and Middle-Income Countries (LMICs) where the university is located, this journey of becoming and being third-space professionals was fraught with challenges that question traditional norms within academia and their culture, requiring innovative problem-solving, continuous learning and accountability. Establishing this new identity involved extensive negotiations to create a new professional stream, gaining recognition from university leaders, and advocating for career pathways. Recognising the demands on third-space women leaders in our contexts, the case study also underscores the importance of workplace structures that support those who work in this critical area. The insights gained may be helpful to others seeking to establish third-space professionals in their professional contexts
Global, regional, and national burden of primary liver cancer attributable to metabolic risks: an analysis of the Global Burden of Disease Study 1990-2021
No full textBackground: The global burden of metabolic diseases is increasing, but estimates of their impact on primary liver cancer are uncertain. We aimed to assess the global burden of primary liver cancer attributable to metabolic risk factors, including high body mass index (BMI) and high fasting plasma glucose (FPG) levels, between 1990 and 2021.
Methods: The total number and age-standardized rates of deaths and disability-adjusted life years (DALYs) from primary liver cancer attributable to each metabolic risk factor were extracted from the Global Burden of Disease Study 1990-2021. The metabolic burden trends of liver cancer across regions and countries by sociodemographic index (SDI) and sex were estimated. The annual percentage changes in age-standardized DALYs rate were also calculated.
Results: Globally, in 2021, primary liver cancer attributable to high BMI and/or high FPG was estimated to have caused 59,970 deaths (95% uncertainty interval [UI]: 20,567 to 104,103) and 1,540,437 DALYs (95% UI: 540,922 to 2,677,135). The age-standardized rates of death and DALYs were 0.70 (95% UI: 0.24 to 1.21) and 17.64 (95% UI: 6.19 to 30.65) per 100,000 person-years. A consistent global rise in liver cancer attributable to metabolic risks was observed from 1990 to 2021, with high BMI identified as the major contributing risk factor. The highest burden of deaths and DALYs of liver cancer consistently occurred in high SDI countries, while the fastest growth trends were observed in low-middle SDI countries. The burdens of high levels of BMI and FPG were higher in men than in women.
Conclusions: Primary liver cancer attributable to high BMI and/or high FPG imposes an increasingly substantial clinical burden on global public health, particularly in high SDI countries. Rapid growth trends are also found in middle-SDI countrie
Risk of pancreatic cancer and high-grade dysplasia in resected main-duct and mixed-type intraductal papillary mucinous neoplasms: A prevalence meta-analysis
No full textBackground: Current guidelines recommend the resection of main duct- (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMN) based on specific risk criteria to prevent or treat pancreatic cancer in selected patients. This paradigm follows high rates of malignancy observed in published surgical series. The aim of this systematic review and meta-analysis was to provide robust, pooled rates of invasive carcinoma (IC) and high-grade dysplasia (HGD) in resected MD- and MT-IPMNs of the pancreas.Methods: The PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL databases were systematically searched. Studies that reported rates of IC or HGD, diagnosed by histopathology of surgical specimens, in MD- or MT-IPMNs were included. Pooled prevalence with 95 % confidence interval (95 % CI) was calculated using a random effects model. Galbraith plots were used to evaluate heterogeneity. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool.Results: Based on 51 studies, 59 % (95 % CI: 54 %, 64 %) of resected MD- and MT-IPMN had IC or HGD, with IC in up to 39 % (95 % CI: 33 %, 44 %) of lesions and HGD in 20 % (95 % CI: 16 %, 25 %). Most studies were deemed to be of good quality and Galbraith plots demonstrated high concordance.Conclusions: These results confirm the rates of IC and HGD in resected MD/MT-IPMNs. However, a significant proportion of patients have benign lesions, and future research is needed to develop precise diagnostics to distinguish between patients with and without high-risk or cancerous disease
Dementia in a resource-constrained sub-Saharan African setting: A comprehensive retrospective analysis of prevalence, risk factors, and management at the only neuropsychiatric facility in Northeastern Nigeria
Full text linkINTRODUCTION: Dementia prevalence is increasing in sub-Saharan Africa, poten-tially due to population growth and aging. Resource-constrained settings such asNortheastern Nigeria face challenges in dementia management.
METHODS: We assessed dementia burden and management at the Federal Neuropsy-chiatric Hospital Maiduguri, the only neuropsychiatric facility in Northeastern Nigeria.This retrospective analysis included patient records from 1999 to 2023 for individuals60 year of age and older with a dementia diagnosis.
RESULTS: Of the 1216 cases reported, Alzheimer’s disease (60.5%) was the mostcommon subtype, followed by vascular dementia (24.5%). Hypertension (41.6%) wasthe most frequent comorbidity. Memory loss was present in all cases, whereasbehavioral symptoms like agitation presented in some cases. Treatments includedcognitive enhancers (donepezil), supplements (gingko biloba), and non-drug therapies(psychoeducation).
DISCUSSION: The increasing burden of dementia at this sole facility highlights theurgent need for targeted interventions and further research to understand theunderlying factors contributing to dementia in this population
Factors associated with stroke recurrence after initial diagnosis of cervical artery dissection
No full textBackground: Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals.
Methods: This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression.
Results: In all, 4023 patients (mean age was 47.4 years; 44.5% were women) were included. By day 180, subsequent ischemic stroke occurred in 5.3% of the cohort. In adjusted Cox regression, factors associated with increased risk of subsequent ischemic stroke were prior history of ischemic stroke (adjusted hazard ratio [aHR], 7.31 [95% CI, 1.61–33.13]; P=0.010), presentation within 7 days from first symptoms (aHR, 3.04 [95% CI, 1.04–8.91]; P=0.043), infarct on baseline imaging (aHR, 9.85 [95% CI, 3.65–26.58]; P
Conclusions: In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups
Human immunodeficiency virus and associated pneumonia
No full textPneumonia is a major global health concern and a leading cause of death worldwide. According to the World Health Organization, pneumonia accounts for over 2.5 million deaths annually, which means almost 1% of all deaths occur every 13 seconds due to this disease. Pneumonia affects approximately 450 million people globally per year, and in the United States alone, about 1 million adults are hospitalized each year because of pneumonia, leading to approximately 50,000 deaths annually. This disease can be caused by various pathogens, including bacteria, fungi, and viruses, and has significant implications for global health, particularly in vulnerable populations like children, the elderly, and immunocompromised individuals.
This comprehensive work aims to explore pneumonia in-depth, detailing its pathology, physiology, and treatment strategies. The book is organized into two sections: Section 1 deals with pneumonia in general, providing a foundation for understanding the disease. Section 2 explores pneumonia in the context of specific conditions and populations, offering a targeted perspective on the disease.
Understanding pneumonia’s multifaceted nature is crucial for effective diagnosis and treatment, especially given its significant impact on global health. This book is designed to provide valuable information for medical students, nurses, clinicians, healthcare providers, and specialists, equipping them with the knowledge necessary to manage patients effectively