Treatment outcomes for maculopathy secondary to retinal vein occlusion in Afghanistan.

OBJECTIVES: The objective of this study was to investigate the efficacy of intravitreal antivascular endothelial growth factor (VEGF) therapy in the treatment of macular edema secondary to retinal vein occlusion (RVO) in Afghanistan. METHODS: A retrospective analysis was conducted of all RVO cases that underwent intravitreal ant-VEGF injection at the two leading hospitals in Kabul. The main outcome measures were visual acuity and central retinal thickness as determined by optical coherence tomography. Information was also collected on the distance traveled by each patient and the frequency of injections. RESULTS: One hundred and twenty-five eyes of 121 patients (86 males) with RVO were identified as having undergone treatment, with a mean age of 53.1 years (range 20-80). The only agent used was bevacizumab. The mean central retinal thickness reduced from 624.2 ± 24.9 µm at the baseline to 257.8 ± 5.7 µm following treatment (P < 0.001). There was a small increase in visual acuity from 1.33 LogMAR at the baseline to 1.13 LogMAR following the most recent injection (P = 0.03, paired t-test). The mean distance traveled by patients was 173.9 km (range 2-447 km). CONCLUSION: Despite the challenges of health-care provision in Afghanistan, this review shows that the use of intravitreal bevacizumab has provided an effective treatment for macular edema after RVO.

Trivial injury with devastating complication-A case of pediatric pancreatic pseudocyst.

Key Clinical Message: Pancreatic pseudocysts are rare in the pediatric population, commonly a result of trauma. Timely diagnosis and adequate management with a multidisciplinary approach are the key to avoid morbidity and mortality. Larger cysts often require surgical intervention. Abstract: We report a case of a 4-year-old female child who presented with a massive pancreatic pseudocyst. Pseudocysts >10 cm are at an increased risk of rupture, hence require surgical intervention. Percutaneous external drainage via pigtail catheter was followed by cysto-gastrostomy due to continuous high output. The postoperative period was uneventful.

A rare case report of vaginoplasty using amnion graft in an Afghan woman with Mayer-Rokitansky-Küster-Hauser syndrome: A first report in Afghanistan.

INTRODUCTION: Mayer-Küster-Hauser (MRKH) syndrome is the second reason for primary amenorrhea. MRKHS is an uncommon congenital disorder characterized by agenesis of mullerrian structures, uterus, and upper two-thirds of the vagina, with normal fully developed secondary sexual characteristics. CASE PRESENTATION: This report describes the case of a 30-year-old married woman with primary amenorrhea. She had normal secondary sex characteristics, but the uterus, cervix, and upper two-thirds of the vagina were absent. She underwent the modified Abbe McIndoe procedure. The amnion membrane was mounted on the mold with a mesenchymal surface outward to adhere surface of the neovagina. After three months, it was not necessary to use the mold and sexual intercourse was recommended. DISCUSSION: The modified Abbe- McIndoe method with amnion graft is save, rapid, and simple procedure. The amnion membrane is easily storable and accessible. Therefore, this technique is effective and simple for developing countries including Afghanistan. CONCLUSION: This case indicates that the modified Abbe McIndoe methods can be used as a safe procedure in the treatment of MRKH Syndrome.

Health-related quality of life in persons with haemophilia in Afghanistan.

INTRODUCTION: Haemophilia is the most common severe congenital bleeding disorder and can significantly influence patients' quality of life. The health-related quality of life (HRQoL) is a multi-dimensional concept that assess effect of different aspects of health status, including physical, mental, and social domains. Identification of the factors affecting the HRQoL of Persons with Haemophilia (PWH) can guide health care system to better management of patients. AIM: The aim of the present study is to evaluate HRQoL in PWH in Afghanistan. METHODS: This cross-sectional study was conducted on 100 PWH in Kabul City, Afghanistan. Data were collected using 36-Item-Short-Form Health Survey (SF-36) questionnaire and analysed using correlation coefficients and regression analysis. RESULTS: The mean scores for the SF-36 questionnaire 8 domains range from 33 ± 38.3 to 58.15 ± 20.5. The highest mean value belongs to physical function (PF) (58.15), whereas the lowest is related to restriction of activities due to emotional problems (RE) (33.00). A significant association (p < .005) was observed between all domains of SF-36 and patients' age except for PF (p = .055) and general health (GH) (p = .75). A significant association was also observed between all HRQoL domains and the severity of haemophilia (p < .001). The severity of haemophilia was the significant predictor for Physical Component Summary (PCS) and Mental Component Summary (MCS) (p < .001). CONCLUSION: Due to the reduced HRQoL in Afghan PWH, special attention by health care system should be paid to improve patients' quality of life.

Estimating the Cancer Treatment Cost for 5 Common Types of Cancer with Separating Out-of-Pocket and Governmental Costs in Afghanistan, 2020.

The objective this study was to estimate the cost of cancer treatment services for 5 common types of cancer (Breast, Esophageal, Colorectal, Stomach and lung) by the public sector and patients. This study was a cross-sectional study that conducted using the medical records of patients who were registered in the Jamhuriyat Hospital from 1, 2020 to 12, 2020. The prevalence-based approach was used to estimate the costs of five major cancer types. The data of 769 patients were eligible to include for the analysis. The considered cost of services was obtained from the average cost in 3 private hospitals in Kabul. Also all costs converted in to US dollar using the exchange rate of each USD equaling to AFN 77 in 2020. The data was analyzed using Ms. Excel Program. The total number of patients with 5 types of cancer were 769. Of these, female, in the age group of 40-60 years and were illiterate. The most common cancers based on the cancer treatment services' costs of health services was breast cancer, followed by esophagus, colorectal, stomach and lung. Moreover, the most common cancers based on the cancer treatment services' costs of health services which cancer patients needed was breast cancer, followed by esophagus, colorectal, stomach and lung.  Moreover, total cost of cancer treatment is US$590,662.98, in which Patients paid USD 82,537 of it out-of-pocket. The costs of cancer treatment services for 5 common types of cancer are high which a considerable portion are paid by patients. There is a need for the government to pay more attention to the provision of these services and to increase the centers providing these services and the existing facilities. Also, support of the international community in this process can enable more people to access these services and reduce the economic burden on patients.

Malaria in Afghanistan: Challenges, efforts and recommendations.

Malaria, a vector borne disease that can quickly become life-threatening, has become endemic to many countries, in particular Afghanistan. Ranking third for world's highest burden of malaria, Afghanistan has found itself in a downward spiral, burdened by outbreaks of not only malaria, but dengue, watery diarrhea and measles as well. The civil conflict and lack of healthcare services present compounded with the COVID-19 pandemic resulted in a five-to tenfold increase of malarial incidence in the past years. Increased refugee shuttling and fluctuating environmental conditions have allowed proliferation of malarial vectors, with restricted access to treatment impeding elimination of malaria as well. Although efforts like larvicides, indoor spraying and initiatives like the Sehatmandi project have been made to control the spread of malaria, further efforts focusing on more sustainable and economical preventative measures are essential. Thus, efforts on both individual and global levels, more research and maintenance of control measures, are necessary to eliminate outbreaks and risks of resurgence.

Concomitant trans-sternal repair of Morgagni hernia and ventricular septal defect in a patient with Down syndrome: A case report.

INTRODUCTION: Morgagni hernia is a rare type of hernia occurring secondary to potential anterior-medial defects in the diaphragm. The association of the defect with congenital cardiac pathologies and Down syndrome are well known. The defect is repaired usually by trans-abdominal or transthoracic approaches. Trans-sternal repair of the hernia is preferred in patients undergoing concomitant open heart surgery. CASE PRESENTATION: A 2-year-old child with Down syndrome underwent concomitant repair of Morgagni hernia and closure of his ventricular septal defect under cardiopulmonary bypass. The hernia was corrected by the sternotomy approach, without opening the hernia content, before the correction of the cardiac pathology. The patient made an uneventful recovery and was discharged on the 4th postoperative day. DISCUSSION: Preoperative diagnosis of diaphragmatic hernia in congenital heart disease is important to decrease mortality rate. However, trans-sternal exposure of the defect is also possible, as in this case, in patients undergoing open heart surgery for congenital cardiac defects. The defect can be repaired by this approach, concomitantly with the cardiac anomaly, no need for an additional incision and without opening the hernia sac. CONCLUSION: Our experience, although very limited, in patients who are suffering from Morgagni hernia and concomitant congenital heart defects shows that simultaneous repair of Morgagni hernia through midline sternotomy prior to cardiac procedure is effective. As Morgagni hernia can be accompanied with many congenital cardiac anomalies, cardiac surgeons should be familiar with the trans-sternal approach to the defect.

Successfully separated conjoined twins at French Medical Institute for Mothers and Children Kabul Afghanistan.

Conjoined twins are a rare malformation and few cases have been reported in the literature. There are different types of conjoined twins and the most common type is the thoracopagus. Prognosis is related to the type of conjoined twins and the organs they share. We are reporting an Omphalopagus, in which there was sharing of the liver, sternum, and abdominal wall. The complications in this kind of cases are Bleeding, Bile leakage, and infection.

The daunting task of fighting HIV in Afghanistan: Current evidence and future recommendations.

The human immunodeficiency virus (HIV), like any other disease, has created great worry in Afghanistan. The country's slew of issues has paved the way for HIV to spread and go unchecked. International groups have banded together to stop the virus's spread since the first case was confirmed in Afghanistan. The cumulative effects of international collaboration have aided in the reduction of cases and improved awareness. Because of their injection use, a large portion of the country's population has been classified as a vulnerable category for HIV infection. Awareness campaigns and international collaboration should be implemented to further limit the spread of HIV.

Prevalence and determinants of self-medication with antibiotics among general population in Afghanistan.

OBJECTIVE: Self-medication with antibiotics (SMA) is a common cause of antibiotic resistance, a major public health problem. This research aimed to identify the prevalence of SMA and explore reasons for practicing SMA among people living in Kabul, Afghanistan. METHODS: A community-based cross-sectional study was conducted from May to November 2017 in 12 community pharmacies operating across Kabul, Afghanistan. Multivariable logistic regression was conducted to identify the factors associated with the use of SMA. RESULTS: Out of 385 participants, 282 (73.2%) practiced SMA during the last year. Overall, 241 (62.6%) were 'very concerned' about the use of SMA, and 156 (40.5%) highlighted it is bad to practice SMA. The top three antibiotics used for self-medication were penicillin (ATC class: J01C), metronidazole (ATC: P01AB01), and ceftriaxone (ATC: J01DD04). Economic problems, lack of time to visit doctors, and ease of use were cited as the main reasons for practicing SMA. Furthermore, female participants were less likely to practice SMA compared to male counterparts. CONCLUSION: While efforts should be directed to enforce strict drug regulations system and awareness programs, priority should be given to provide accessible, affordable, and quality health care services to increase citizen's compliance to appropriate drug prescriptions.

Assessment of Knowledge, Attitude, and Practice of Health-Care Workers Towards Hepatitis B Virus Prevention in Kabul, Afghanistan.

BACKGROUND: Hepatitis B virus (HBV) infection is a serious public health issue around the world. Health care workers (HCWs) are at high risk of HBV infection because they have direct contact with HBV infected blood and body fluids in their work. OBJECTIVE: The purpose of this study was to evaluate the knowledge, attitude, and practice (KAP) of HCWs towards hepatitis B infection in Kabul, Afghanistan. METHODS: This cross-sectional study was conducted on 502 HCWs, between November 2018 and January 2019 by a simple random sampling method. The data was collected through a self-administered structured questionnaire. Using this questionnaire, demographic characteristics and KAP of HCWs was assessed. In addition, descriptive and inferential analyses was conducted on the collected data using SPSS 16 (SPSS Inc., Chicago, IL, USA). RESULTS: The overall KAP scores of HCWs were found to be 86.58%, 34.73%, and 61.22%, respectively. Most of the participants correctly recognized the HBV infection. Among the participants, only 77.45% had undergone screening for HBV, and 56.37% had received HBV vaccine (p < 0.0001). Moreover, only 6.77% had completed the three doses of vaccination for HBV. Among the HCWs, the group with higher education level had better knowledge than the group with lower education level. However, the attitude of most of the participants towards HBV prevention was found to be inadequate (53.98%). CONCLUSION: This study shows that HCWs in Kabul, Afghanistan are at high risk of HBV infection due to low vaccination coverage and inadequate infection control. Therefore, we strongly encourage providing an accessible and compulsory vaccination program for all HCWs to improve their attitude and awareness towards HBV infection and to achieve effective infection control.

Food security and COVID-19 in Afghanistan: a two-sided battlefront.

Food security is a major element for the sustainability, stability and development of a country. However, despite fundamental efforts in fighting poverty, Afghanistan continues to struggle with food insecurity with a large proportion of its population living below the poverty line. With extreme climates, protracted conflict, and now COVID-19, food insecurity has become rampant and is on the rise in the country. Efforts have been reinforced to mitigate this issue, but a spate of obstacles which seems not to come to an end, has contributed to the deterioration of the situation. With the collaboration and efforts of international organizations, there remains a glimmer of hope to potentially reduce the gravity of the food insecurity in the country. This paper aims to highlight the efforts of Afghanistan in alleviating food insecurity with a focus on the impact of COVID-19 on this issue. It also presents recommendations that may help ameliorate the country's food security status during and after the pandemic.