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Early Onset Type 2 Diabetes And Associated Risk Factors, Grace Nyambura Kiraka

Theses & Dissertations

Background: The incidence of type 2 diabetes in patients below the age of 40 (early onset diabetes) is markedly on the rise and has been linked increased prevalence of risk factors such as the metabolic syndrome and family history of diabetes.

Objective: To determine the proportion of patients with type 2 diabetes at Aga Khan University Hospital Nairobi (AKUHN) who have early onset type 2 diabetes and the association of age of onset with risk factors (family history of diabetes, obesity, waist circumference, hypertension, low HDL cholesterol and hypertriglyceridaemia) in this group of patients.

Methods: This was a …

Prevalence Of Acute Kidney Injury Using Urine Neutrophil Gelatinase Associated Lipocalin As An Early Biomarker In Neonates With Perinatal Asphyxia, Farida Essajee

Theses & Dissertations

Introduction: Perinatal asphyxia is a major cause of neonatal morbidity and mortality. Acute kidney injury (AKI) is a common complication of perinatal asphyxia occurring in up to 61% of the neonates. Currently the diagnosis of AKI is based on serum creatinine levels and clinically by oliguria, however these are late markers of the disease. More novel biomarkers are emerging that predict the diagnosis early. Current research indicates urine NGAL as an early marker for AKI, yet there is paucity of data about its use in term neonates with perinatal asphyxia.

Objectives: This study aimed to investigate the prevalence …

Primary Antiretroviral Drug Resistance Profiles Among Hiv-1 Therapy Naïve Patients In Two Referral Hospitals In Kenya, Simon Onsongo Nyangena

Theses & Dissertations

Objective: To characterize antiretroviral drug resistance mutations among drug naïve patients in two referral hospitals in Kenya

Background: Acquired immunodeficiency syndrome (AIDS) caused by Human immunodeficiency virus (HIV) was first described in 1982. Since then the virus has spread globally to infect millions of people. HIV was first described in Kenya in the period between 1984/1985. Currently, Kenya has an estimated HIV-1 prevalence of 6.2% with a country population of about 40 million people. With the introduction of antiretroviral drugs, the survival of most HIV patients has been prolonged markedly. However this is greatly threatened by increasing rates of antiretroviral …

Effects Of Hypo And Iso - Tonic Intravenous Maintenance Fluids On Plasma Sodium Level In Hospitalized Children. A Double Blind Randomized Clinical Trial, Ismail Ahmed

Theses & Dissertations

Background: Hypotonic fluids are widely used in pediatrics and are the standard of care when giving maintenance fluids. However, there are several reports of risk of iatrogenic hyponatremia attributed to this practice in the literature. There is therefore uncertainty as to whether isotonic fluids would be the more appropriate fluid.

Objectives: The primary objective was to compare effects of hypotonic and isotonic maintenance fluids on plasma sodium levels in children between the ages of 2 months and 15 years admitted at Aga Khan University Hospital (AKUH). The secondary objective was to compare effects of hypotonic and isotonic maintenance …

The Prevalence And Factors Associated With Nonadherence With Arv Treatment And Cotrimoxazole Preventive Therapy Among Hiv Infected Adolescents Attending Out-Patient Hiv Clinics In Kenya, Reson Marima

Theses & Dissertations

Background: There is an increase in the burden of HIV infected adolescents, both those perinatally infected as well as those acquiring HIV during adolescence. Female adolescents continue to be at the highest risk for acquiring HIV; in many Southern African countries, they have a three fold risk of acquiring HIV compared to their male counterparts. Adherence to treatment among adolescents has been shown to range between 30-70%, which is unacceptably low for antiretroviral therapy (ART). Psychosocial wellbeing and social support have been shown to be possible contributing factors to adherence to ART. This relationship has not been previously evaluated …

Prevalence Of Urinary Tract Infections In Febrile Children And Role Of Urine Interleukins In Diagnosis, Anne J. Rerimoi

Theses & Dissertations

Background: Urinary tract infections (UTI) are common in the paediatric age group and can contribute to permanent renal damage. Urine culture takes a minimum of 48 hours, thus delaying treatment in suspect cases. It is also expensive and requires training of laboratory technologists. Early diagnosis is important in prevention of serious sequelae such as hypertension and end stage renal disease. Determination of burden of the problem within a population allows appropriate allocation of diagnostic and management resources. Urine interleukins are postulated to be useful adjuncts in diagnosis of UTI.

Objectives: The primary objective was to determine the prevalence of UTI …

A Randomised Comparative Trial Of Seven Versus Fourteen Day Triple Therapy For Helicobacter Pylori Eradication At The Aga Khan University Hospital, Nairobi, Ahmed Sokwala

Theses & Dissertations

Background: Helicobacter is associated with a number of important upper gastrointestinal conditions including chronic gastritis, peptic ulcer disease, and gastric malignancy. Proton pump inhibitor -based triple therapies are considered the standard regimens for Helicobacter pylori eradication, but the optimal duration of these regimens is still controversial. Local studies are required to evaluate the H. pylori eradication rates in a country for adequate eradication to prevent H. pylori infection and complications

Objectives: The main objective of this study was to compare 7 day and 14 day regimens and determine the optimum duration of triple therapy for H. pylori eradication.

Methods: A …

Risk Of Contrast Induced Nephropathy In Hiv Patients Receiving Radiographic Contrast At Three Aga Khan Hospitals, Sitna A. Mwanzi

Theses & Dissertations

Aim: To study the influence of HIV infection on the development of contrast induced nephropathy in patients receiving radio contrast material

Design: Prospective cohort study

Patients and setting:One hundred and twenty five (125) HIV positive patients and one hundred and fifty five (155) HIV negative patients selected from in and out patient departments of the Aga Khan University Hospital, Nairobi and Aga Khan Hospitals in Mombasa and Kisumu, were evaluated for the study between August 2008 and August 2009.

Methodology: Eligible patients undergoing radiological evaluation requiring the use of radio contrast material were consecutively recruited for the study after …

Use Of Magnetic Resonance Spectroscopy (Mrs) To Improve Magnetic Resonance Imaging (Mri) In The Diagnosis Of Intracranial Pathology, Done At Aga Khan University, Joyce Sande

Theses & Dissertations

Introduction: Magnetic Resonance Spectroscopy (MRS)is a potentially useful adjunct to Magnetic Resonance Imaging (MRI) in thecharacterization of focal brain lesions. This study was aimed at showing that by the additional use of MRS (MRI, MRS), the characterization of a focal brain lesion into neoplastic, or non- neoplastic (infective, or degenerative) can be improved, as compared to the use of MRI alone.

Study question: Does the additional use of MRS improve MRI differentiation of neoplastic from non- neoplastic (infective or degenerative) focal brain lesions?

Methods: The design was prospective, analytical and comparative. 80 consecutive patients were enrolled. Conventional MRI of the …

Outcome Of Chronic Anal Fissures Treated With Glyceryl Trinitrate At Aga Khan University Hospital Nairobi, Ilkul H. Johnbosco

Theses & Dissertations

Background: The medical treatment for chronic anal fissure is modeled to eliminate sphincter spasm and hypertonia so that blood flow to the anal sphincter improves and the fissure heals. Efficacious pharmacological therapy avoids complications related to surgical treatment including incontinence and the risks of surgery and anesthesia. Conservative treatment of chronic anal fissure has been reported with wide variation in the healing rates. However there are few reports of conservatively treated chronic anal fissures fromAfrica, with only one paper identified in this study. Furthermore, the influence of clinical characteristics of fissures on the healing rates and recurrences have not been …

The Influence Of Antiretroviral Therapy On Qtc Interval Amongst Hiv Patients At Aga Khan University Hospital, Nairobi, Jay Shavadia

Theses & Dissertations

Aim: To determine the influence of antiretroviral (ARV) therapy on the QT_C interval amongst HIV-infected patients.

Design: Prospective Comparative survey of two population samples

Patients and Setting: One hundred and thirty ARV naïve and one hundred and thirty treated HIV-positive patients selected from in and out patient departments of Aga Khan University Hospital underwent clinical evaluation and 12 lead resting ECG between August 2008 and March 2009.

Methodology: Eligible HIV-positive patients were conveniently sampled and had a 12-lead electrocardiogram (ECG) performed to determine the QTinterval, corrected for the heart rate by the Bazzet formula. Analysis was then performed to …

Cumulative Incidence Of Post Dural Puncture Headache Following Caesarean Section Under Spinal Anaesthesia At The Aga Khan University Hospital Nairobi, Ednah K. Gisore

Theses & Dissertations

Introduction: Post dural puncture headache can be a debilitating complication of subarachnoid anaesthesia for a new mother. Successful management of post dural puncture headache requires adherence to clear policies and protocols with close follow up of patients by an experienced obstetric anaesthetist.

Objective: This study examined the cumulative incidence and severity of post dural puncture headache in obstetric patients who consented for spinal anaesthesia for caesarean section at the Aga Khan University Hospital, Nairobi.

Study site: The Aga Khan University Hospital, Nairobi.

Study Design: Prospective Cohort study.

Study Population: All women who underwent caesarean sections under spinal anaesthesia and …

The Prevalence Of Postoperative Pain Following Day Surgery In The First 48 Hours At Aga Khan University Hospital, Nairobi, Gilbert Mwaka

Theses & Dissertations

Introduction: Day case surgery services are increasing all over the world. The prevalence of postoperative pain after day surgery is found to be high ranging from 17% to 60%. Little is known about the prevalence of postoperative pain, in Kenya and East Africa, after day case surgeries.

Objective: The objectives of this study were to investigate the prevalence of postoperative pain after day surgery at Aga Khan University (AKUH), Nairobi, to determine the severity/intensity of postoperative pain following day case surgery, and to determine the influence of anxiety and worry on the patients report on postoperative pain.

Study site: The …

Primary Health Care Providers’ Knowledge And Practices On Asthma Management Within Dar Es Salaam Region Health Facilities, John C. Rwegasha

Theses & Dissertations

Background: Asthma is a common chronic health problem worldwide with considerable variation in the way it is managed. In the sub- Saharan Africa there is substantial gaps in asthma care; countries like Tanzania with inadequate health care structure are lagging far behind in both correct diagnosis and management of asthma. The increasing prevalence of asthma within populations is attributed to a number of the following factors; Patient behavior, Health service structure and access, Environmental factors and Provider's knowledge and practices. There is lack of required standard asthma care under provider's factors, hindering effective control of the disease. This could be …

A Randomised Comparative Clinical Trial Of Prokinetic Agents And Proton Pump Inhibitors In H. Pylori Negative Non-Ulcer Dyspepsia, Mzee Ngunga

Theses & Dissertations

Aim: To compare the efficacy of prokinetic agents and proton pump inhibitors in symptom relief of patients with non-ulcer dyspepsia.

Design: Comparative prospective single blind clinical trial.

Patients and setting: Fifty four cases of non-ulcer dyspepsia in whom H. pylori has been eradicated were seen in the specialist gastroenterology clinic of a tertiary care hospital.

Methodology: Patients with dyspepsia and negative endoscopy for peptic ulcer disease, gastro-oesophageal reflux disease, hiatus hernia and upper gastrointestinal malignancy in whom H pylori has been eradicated but still had dyspepsia were assessed and scored using the modified Glasgow dyspepsia severity score (GDSS) at baseline. …

Day Care Surgery At A New University Teaching Hospital: A Review Out Of The Aga Khan University Hospital, Nairobi, Edwin Mogere

Theses & Dissertations

Introduction: Day Care Surgery (DCS) is the surgical care of patients on a planned non-residential basis. The objective of the study was to assess the performance of DCS in the context of a developing country within the private sector. Data from a new DCS unit was compared to internationally accepted indicators of the quality of care.

Methodology: A hospital based retrospective chart review of all patients operated on within 10 surgical subspecialties was performed. The review period was the June 2006 to July 2007(12 months).

Analysis (SPSS version 11.5): Outcome measures included in-patient to DCS ratio in the various specialties; …

Prevalence, Risk Factors And Outcome Of Acute Kidney Injury At The Aga Khan University Hospital Nairobi, Peter W. Munyu

Theses & Dissertations

Introduction: Acute kidney failure (acute kidney injury, AKI) is a group of syndromes that result in a decline in the glomerular filtration rate. In 2002, the Acute Dialysis Quality Initiative (ADQI) group proposed the RIFLE criteria to standardize the definitions of AKI severity and outcome. This criterion has been validated in several studies. AKI is frequently encountered in hospitalized patients; it has a negative impact on mortality and morbidity. A lot of work has been done to describe the epidemiology of AKI in developed countries. The same does not apply for developing countries. This study was designed to evaluate AKI …

Self-Efficacy In Type 2 Diabetics, Joan M. Hyett

Theses & Dissertations

There are 1.2 million diagnosed diabetics in Texas, 10 % of whom live in Bexar County, Texas. Diabetes is rated as the fifth leading cause of death in the same county. In addition to the diagnosed cases, it is estimated that 125,000 adults in Bexar County have undiagnosed diabetes (Foy, 1999). Diabetic education may prevent complications in some individuals, but sometimes knowledge alone is not enough. Patients often lack motivation or self-confidence in their capacity for self- management of their diabetes. Diabetic educators are often faced with the challenge of not only educating but also motivating patients to be compliant …

Stress Experienced By Respite Care Workers And Family Caregivers When Caring For Alzheimer's Patients, Monica D. Minewiser

Theses & Dissertations

Changing demographics and cost containment in health care in caring for the Alzheimer's Disease (AD) patient has given birth to a growing need for respite care workers. The purpose of the study was to determine whether the stress level of a respite care worker who works with an AD patient in a noninstitutionalized setting on a daily basis will be significantly less than that of a family caregiver when caring for an AD patient. The Revised Memory and Behavior Problem Checklist (RMBPC) was the instrument used to measure stress. This is a questionnaire consisting of 24 questions and allows 5 …

The Effectiveness Of A Preoperative Patient Education Handbook In Decreasing Anxiety Of Veterans Undergoing Elective Surgery, Garletta White Steen

Theses & Dissertations

The purpose of this experimental, pretest/posttest study was to examine the effectiveness of a preoperative patient education handbook developed by postanesthesia care unit (PACU) nurses in decreasing state anxiety of veterans undergoing minor elective surgery. State anxiety was measured by the State Anxiety Scale of the State-Trait Anxiety Inventory, developed by Spielberger, Gorsuch, Luschene, Vagg, and Jacobs (1983). The population for the study was composed of veterans undergoing elective surgery in a hospital which is part of the South Texas Veterans Healthcare System. The sample consisted of 38 patients admitted to the hospital for a variety of minor elective surgeries. …

The Impact Of A Health Education Program On The Attitudes Of African-American Hypertensive Clients Regarding Adherence To A Prescribed Medical Regimen, Teresa Y. Mcpherson

Theses & Dissertations

This quasi-experimental study examined the effect of an educational program on the attitudes of hypertensive African-American clients regarding their adherence to a prescribed medical regimen.

Despite increased public awareness and improved treatment in hypertension, poorly controlled hypertension continues to be a significant problem especially among blacks and other minority populations in the United States (Shea, Misra, Ehlich, Field, & Francis, 1991). On the basis of different experiences, people may form different beliefs and, therefore different attitudes about the consequences of performing or not performing a behavior (Ajzen & Fishbein, 1980). Studies have indicated that a variety of factors such as …

Spirituality Among Terminally Ill Hospitalized Adults And Healthy Non-Hospitalized Adults In A Military Environment, Richard M. Holt

Theses & Dissertations

The purpose of this study was to identify whether or not terminally ill hospitalized adults indicated greater spirituality and well-being than healthy non-hospitalized adults. Reed's (1986b & 1987) studies are the bases for this treaty although this is not a replicate study. The conceptual framework of this research is founded on the developmental life-span, and energy field patterns (Rogers, 1980) impacting spirituality and well-being. It was hypothesized that terminally ill hospitalized adults indicate greater spirituality than healthy nonhospitalized adults in a military environment. A terminally ill and healthy adult group of N=30, (n=15 each) were selected for a convenience sample. …