As the life expectancy in thalassemia is improving, pain is being recognised as an emerging problem. There is a need for prospective observational study of pain in these high risk patients.

Objectives: Assess the pain prevalence, severity and impact of co-morbidities in thalassemia.

Methods : All patients >10 years of age (n=165) attending Thalassemia Day Care Center of a tertiary

care hospital were assessed for pain prevalence, severity and its effect on various life activities using Brief Pain Inventory. Their medical records were reviewed for the presence

of various comorbidities.

Results: Pain was reported by 62.4% participants with 35.2% and 59.4% participants, reporting pain in past 1 week and 4 weeks respectively. A significantly higher pain prevalence was

reported in females (p=0.03), patients residing in urban areas (p=0.03) and employed participants (p=0.03). The commonest sites of pain were lower back and calves. General activity (p=0.02) and enjoyment of life (p= 0.02) were significantly effected due to pain in patients between 21 to 30 years of age. Female participants reported interference of pain with mood (p=0.03). A

significant relation of pain prevalence was found with higher average serum ferritin (p =0.015), moderate to severe liver iron concentration (p= 0.04) and lower levels of 25 hydroxy vitamin D levels (p=0.03).

Conclusion:Pain is an emerging cause of morbidity in thalassemia. The study found significant association of pain with modifiable factors such as serum ferritin, LIC, 25 hydroxy vitamin D levels.

Nairobi City County, with its major, informal urban settlements, is home to a large and growing proportion of people living with HIV. Alike in other cities, urban dynamics – such as high mobility, high population density and high concentrations of marginalized, fragile and stigmatized communities – create and exacerbate vulnerability to HIV infection (The Nairobi City County HIV Fast Track Report 2015).he youth. Nairobi City County Health Management team, is working to eliminate mother-to-child transmission (MTCT) in Nairobi’s informal settlements.  In 2016, the Kariobangi Health Center (HC), located in Kasarani Sub-county, recorded a high early infant diagnosis (EID) positivity rate of 6.1% (NASCOP EID 2015 .hence comprehensive strategy to reduce MTCT was necessary. The objective of the study was to establish the most effective interventions in eliminating mother to child transmission (MTCT) in Kariobangi H/C through comprehensive Provision of comprehensive eMTCT services. 

Methodology 

From October 2016 to March 2017, a strategy to improve delivery of prevention of MTCT (PMTCT) services was implemented. HTS counselors performed HIV testing at first antenatal care (ANC), labor and delivery, and six-week postpartum visits to ensure timely initiation of ART and follow-up.  Mentor Mothers conducted aggressive follow-up with clients who declined ART, Continuous medical education and on-the-job training were done to capacitate nurses to provide PMTCT care, Monthly Work Improvement Team (WIT) meetings were held to review the PMTCT continuum of care and   Peer education and psychosocial support

Results 

Timely ART initiation for PMTCT clients has led to high ART uptake in Kariobangi HC. Rates of ART provision were sustained with 100% (110) of HIV-infected pregnant women provided with ART in 2016 and 100% (93) in 2017.and the interventions have also led to a reduction in HIV positivity for infants under the age of 12 months from 6.1% in 2016 to 2.4% in 2018 %.

Conclusion

Provision of comprehensive PMTCT services, timely ART initiation, and continuous follow up of the mother-baby pair are key in reducing pediatric HIV infections and ultimately preventing child deaths.

 

Cystic fibrosis (CF) is an inherited autosomal recessive disorder caused by genetic mutations in CFTR protein. The FDA approved various CF gene modulators, the most recent was the next-generation gene therapy in 2019. This paper aimed at the efficacy of the first triple gene therapy in children and adolescents suffering from cystic fibrosis. A systematic review and metanalysis was conducted following PRISMA guidelines through PubMed/Medline, Clinical trials.gov, Google Scholar, Scopus, Embase, and Europe PMC using the keywords: “Ivacaftor,” “Elexacaftor,” “Tezacaftor,” VX_661”, VX_770”, “VX_445”, “cystic fibrosis” and “gene therapy.” A total of ten randomized clinical trials were included for analysis. Significant absolute change was demonstrated from baseline through 4 weeks favors toward the triple CF gene potentiators in predictive FEV1 [MD=11.80,95%CI=8.47_15.12, p value=<0.00001]; as well as CF_QR score [MD=0.00,95%CI=-2.50_2.50, p value=1.00], and BMI kg/m² change [MD=16.90,95%CI=12.73_21.06, p value=<0.00001]. On the same hand, non-significant change was noticed for chloride ion channels activity in treatment group when compared to placebo or VX_770/VX_661 [MD= -12.57,95%CI=-94.46_69.32, p value=0.76]. For Ivacaftor therapy, only a significant reduction in sweat chloride test value toward the treatment group was observed by Ramsey et al., Davies et al., and Moss et al. through 24 weeks [MD=-35.89,95%CI=-59.31_-12.47, p value=0.003]. Tez/Iva group showed no difference between treatment and placebo in term of p FEV1 [MD=1.72,95%CI=-0.95_4.39, p value=0.21]; sweat chloride test [MD=-4.33,95%CI=-10.43_1.78, p value=0.16]; respiratory domain score [MD=5.10,95%CI=2.99_7.21, p value=<0.00001]; and a non-notifiable BMI change from baseline [MD=0.03,95%CI=-0.09_0.14, p value=0.66]. In children aged ≥ 6 y old and adolescents with F508del_CFTR mutation, Elexacaftor–Tezacaftor–Ivacaftor tend to be more effective than first-generation therapy, which showed promising results by improving the lung function, body weight, and respiratory-related quality of life.