General practitioners (GPs) could have an important role in early diagnosis of autism. There have been no studies evaluating the knowledge of GPs regarding autism in Pakistan. We aimed to fill that gap by assessing knowledge and attitude of GPs in Karachi regarding autism. We conducted a cross-sectional survey of 348 GPs; only 148 (44.6%) had heard of "autism." Our results show that GPs less than 30 years of age and those who obtained their Medical Degree in the last 5 years are more likely to report knowledge about autism: OR = 3.0; 95% CI: 1.71, 5.31, and OR = 2.56; 95% CI: 1.48, 4.42, respectively. In addition, among those reporting knowledge about autism, many held misconceptions regarding the signs and symptoms and etiology.

BackgroundReports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area.MethodsBetween September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site.Results969 children aged 2 months-5 years were evaluated. Mean age was 21 ± 15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, Staphylococcus aureus (20.9%), Salmonella typhi (20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. Streptococcus pneumoniae and non-typhi Salmonellae each accounted for 7.6%. Although not the leading cause of bacteremia, Streptococcus pneumoniae was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge.ConclusionS. typhi is a significant cause of vaccine-preventable morbidity while S. pneumoniae may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.

Radiologic data are increasingly important in clinical care guidelines for neurologic disorders and in the conduct of clinical trials assessing novel therapies. The infrastructure and expertise for neuroradiologic evaluations remain scarce in resource-limited settings, but where available, MRI and CT capacity can offer new insights into common, globally devastating diseases. In vivo data for frequently fatal tropical conditions such as cerebral malaria have been largely limited to autopsy studies, which only provide information on nonsurvivors at a single point in time. New imaging facilities in sub-Saharan Africa offer opportunities for expanded research on tropical neurologic disorders.1 However, data management challenges hamper the research utility of radiologic evaluations.Traditional methods of capturing radiographic data from neuroradiologic evaluations provided for clinical purposes rely on unstructured narrative descriptions. Narratives are unsuitable for research analysis for several reasons: the text data are not structured for statistical analysis; reports are rarely standardized among radiologists or among institutions; determining whether an unmentioned feature is absent or inadvertently disregarded in the narrative is frequently impossible; searching for unambiguous words in text reports to develop a database (e.g., swelling vs edema) is haphazard; and, as with many physician-driven technologies, clinical interpretations may have considerable inter-and intrareader variability.To improve the utility of MRI in clinical research of cerebral malaria, we devised a data entry application and workflow instrument, NeuroInterp. As an instrument, NeuroInterp prompts radiologists to systematically glean data from their evaluations. As a workflow instrument, NeuroInterp ensures that serial readings are evaluated by multiple readers with discordant data identified and adjudication addressed. This methodologic approach to developing a data management instrument for MRI data could also be applied to other tropical conditions whose radiographic correlates have not been well-characterized.The NeuroInterp instrument. Development of the NeuroInterp instrument began in 2008, when, as part of a long-standing NIH-funded study of pediatric cerebral malaria, brain MRI acquisition became part of the standard evaluation of comatose patients admitted to the pediatric research ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. 1CT and autopsy studies of cerebral malaria suggested a number of likely radiographic findings, including acute edema, chronic atrophy, inflammatory lesions, and ischemia.2,3 To develop appropriate items for inclusion in the NeuroInterp platform for pediatric cerebral malaria findings, 2 years of narrative-based findings were summarized and distilled into discrete items for structured entry. Two fellowship-trained radiologists, one in neuroradiology (M.J.P.) and one in MRI (S.D.K.), read all studies. The radiologists reviewed all MRIs from the research ward and collaboratively developed a sy...