Medicine and Health Sciences Commons^™

Risk Of Post-Ercp Pancreatitis In Liver Transplant Patients: Single Center Experience, Shailender Singh

Theses & Dissertations

Introduction: Acute pancreatitis remains the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The exact cause of post-ERCP pancreatitis (PEP) is unclear. Regardless of the mechanism that initiates PEP, the pathways of inflammation are similar to other forms of acute pancreatitis and include the activation of various inflammatory cytokines, released from the acinar cells and subsequently from helper T lymphocytes and macrophages. Liver transplants (LTx) patients on immunosuppressive medications have impaired T-cell response and hence decreased ability to generate these cytokines. The aim of this study was to review incidence rates and risk factors of PEP in this …

Cpap-Mad Combination Therapy For Cpap Intolerant Patients With Moderate To Severe Osa, Jacob Stadiem

Theses & Dissertations

The treatment of obstructive sleep apnea (OSA) allows for a multidisciplinary approach between dentistry and medicine. Continuous positive airway pressure (CPAP) is the gold standard for OSA treatment, but the non-adherence rates are high. The mandibular advancement device (MAD) has a higher acceptance rate than the CPAP, however the efficacy is much lower in cases of moderate to severe OSA. This thesis attempted to evaluate if there was a change in compliance when a MAD was added as a combination therapy to moderate to severe OSA subjects that were currently non-compliant with their CPAP. In addition, the change in air …

Novel Therapeutic Strategies For Treatment Of Castration-Resistant Prostate Cancer, Matthew A. Ingersoll

Theses & Dissertations

Prostate cancer (PCa) remains the most commonly diagnosed solid tumor and is the third leading cause of cancer-related death in United States men. While androgen deprivation therapy is the current standard-of-care treatment for metastatic PCa, most patients eventually relapse and develop castration-resistant (CR) tumors, for which there is currently no effective treatment. Therefore, synthesis of novel therapeutic agents and identification of alternative target proteins are necessary to improve treatment. Herein, I investigate the efficacy of novel imidazopyridine and statin derivatives as alternative therapeutic compounds. These molecules not only inhibit androgen receptor signaling, but also block activation of the AKT axis, …

Dopamine Levels In The Brain Of Rat Models Of Human Rheumatoid Arthritis, Amelia Stinson

Theses & Dissertations

Research Focus. Rheumatoid arthritis (RA) is a chronic, debilitating, autoimmune disease that causes the destruction of bone tissue and the articular structures of joints. At least 30% of RA patient populations have cognitive impairment. Acidic dopamine (DA) is the principal neuroimmunotransmitter that links the central nervous system and peripheral nervous system together. The aim of the present study was to determine the levels of DA and its two acidic metabolites: 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in arthritic induced rats, and whether their levels vary across four different parts of the brain: amygdala (AMG), front cerebral cortex (CX), hippocampus …

Prevalence Of Positive Depression Screen Among Post Miscarriage Women At The Aga Khan University Hospital, Steve Kyende Mutiso

Theses & Dissertations

Introduction: Miscarriages are a common pregnancy complication affecting about 10-15% of pregnancies. Miscarriages may be associated with a myriad psychiatric morbidity at various timelines after the event. Depression has been shown to affect about 10-20% of all women following a miscarriage. However, no data exists in the local setting informing on the prevalence of post-miscarriage depression.

Objective: To determine the prevalence of positive depression screen among post-miscarriage women at the Aga Khan University hospital, Nairobi.

Methods: The study was cross-sectional in design. Patients who had a miscarriage were recruited at the post-miscarriage clinic review at the gynecology clinics …

Bedtime Fading With Response Cost For Treatment Of Sleep Disturbances In Children With Autism Spectrum Disorder, Sela Ann Sanberg

Theses & Dissertations

As many as 82% of children with Autism Spectrum Disorders (ASD) experience numerous chronic sleep-related problems and at a much higher frequency and severity than their typically developing peers. Behavioral treatments are considered best practice and first-line treatment to address sleep problems. These treatments tend to address one specific sleep-related behavior at a time. Bedtime Fading with Response Cost (BFRC) is a promising intervention that targets a multitude of sleep problems concurrently and has yet to be replicated by more than one investigative team in the home setting with children on the autism spectrum. This study evaluated the effectiveness of …

Dnmt3a Haploinsufficiency Provokes Hematologic Malignancy Of B-Lymphoid, T-Lymphoid, And Myeloid Lineage In Mice, Garland Michael Upchurch

Theses & Dissertations

DNA methyltransferase 3A (DNMT3A) is a master epigenetic regulator of benign and malignant hematopoiesis. To dissect the biological consequences of homozygous and heterozygous Dnmt3a inactivation in malignant hematopoiesis, we generated Dnmt3a homozygous null (Dnmt3a^Δ/Δ) and Dnmt3a heterozygous (Dnmt3a^+/–) mice and compared the presentations of hematologic malignancies between cohorts. Bi-allelic inactivation of Dnmt3a results in the presentation of mature lymphoid neoplasms resembling chronic lymphocytic leukemia (CLL; B220⁺CD19⁺CD5⁺; 88% penetrance (37/42)) and CD8+ peripheral T-cell lymphoma (PTCL; TCRβ⁺CD3⁺CD8⁺CD4^—; 40% penetrance (17/42)). …

Prevalence Of Cytotoxin Associated Gene-A Positive Strains In Children With Symptomatic H. Pylori Infection, Patricia Mumbi Muriithi

Theses & Dissertations

Introduction: Helicobacter pylori is a common bacterial infection in humans with early acquisition in childhood. It is adapted to the gastric environment and has been associated with chronic active gastritis, peptic ulcers, atrophic gastritis, gastric adenocarcinoma and mucosa associated lymphoid tissue (MALT) lymphoma. H. pylori strains bearing the Cytotoxin Associated Gene-A (CagA) gene have enhanced pathogenicity and have been strongly linked with increased risk for gastric carcinoma in adulthood.

Objectives: The primary objective was to determine the prevalence of CagA positive strains in children with H. pylori infection. The secondary objectives were to compare CagA status and endoscopy findings and …

Patients’ Level Of Knowledge And Perception Of The Involvement Of Post-Graduate Trainees In Their Surgical Care At Aga Khan University Hospital, Nairobi., Jane Mugure Githae

Theses & Dissertations

Introduction: Surgical training is fashioned on a system of graduated responsibilities and independence for acquisition of skills and competence. While many benefit from acquisition of these skills, few would want to be the ‘practicing ground’ for the trainee surgeon. Moreover, disclosure is inappropriate and surgical care does not specifically spell out the role of the surgical trainee in these procedures.

A pilot survey conducted on 20 first-time patients presenting to General Surgery and Orthopaedic Clinics at Aga Khan University Hospital, Nairobi, revealed varied understandings as to who is a post-graduate surgical trainee.

Objective: To explore the patients’ level …

Correlation Between Ovarian Volume And Polycystic Ovarian Syndrome Using Ultrasound., Ndecho Muriuki Guandaru

Theses & Dissertations

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine abnormality in women of reproductive age with a prevalence of 5-10% in different populations. The prevalence of PCOM in patients with PCOS has been shown to be ≥ 90% in different populations. Diagnostic evaluation accounts for a relatively minor part of the total costs of providing care and evaluating women with PCOS. Hence more widespread and liberal screening for the disorder appears be a cost-effective strategy in susceptible patients. PCOM on ultrasound is diagnosed if one of the following is present in one or both of the ovaries; Ovarian volume …

Association Between Calcaneal Spurs And Plantar Fasciitis: A Study Comparing Heel Plain Radiography And Sonography, Micah Silaba Ominde

Theses & Dissertations

Background: Heel pain is a common clinical entity that requires appropriate diagnostic evaluation. Multiple clinical conditions are known to cause heel pain but plantar fasciitis is the most common. Calcaneal spurs are thought to be associated with heel pain and plantar fasciitis but conclusive studies to prove this are sparse. Plain radiography is usually the first line imaging modality for imaging patients with heel pain. Magnetic Resonance Imaging is the gold standard for diagnosing plantar fasciitis but studies have shown ultrasound to be comparable in sensitivity and specificity. The aim is to establish whether a relationship exists between calcaneal spurs …

A Randomized Controlled Trial Comparing The Proportion Of Hypoxia In Sedated Adults Undergoing Upper Gastrointestinal Endoscopy Using Target Controlled Infusion Of Propofol Versus Intermittent Boluses., Catherine Ndosi

Theses & Dissertations

Background: A wide variety of sedation techniques are employed to facilitate various invasive diagnostic and therapeutic procedures. Increasingly, propofol is emerging as the preferred sedative agent. Traditionally, it has been administered as intermittent boluses to achieve deep sedation to facilitate gastrointestinal endoscopy. Propofol target controlled infusion can be employed to provide suitably conducive conditions for this purpose.

Objective: The primary objective sought to compare the proportion of hypoxia between the study group receiving intermittent boluses of propofol at 0.25mg/kg as needed, and the other receiving target-controlled infusion of propofol at 2.5mcg/ml during upper gastrointestinal endoscopy. The secondary objectives were to …

Validation Of The Iief - 5 Questionnaire In A Clinic Population At Aga Khan University Hospital, Nairobi, Denis Otim

Theses & Dissertations

Background: Men with lower urinary tract symptoms (LUTS) are at risk of erectile dysfunction (ED) and other co - morbidities. The clinical assessment of ED is unreliable and the International Index of Erectile Function – 5 (IIEF – 5) a widely used tool is not validated in our setting. We aimed to validate the IIEF – 5 as a screening tool for ED in men with LUTS visiting the outpatient services.

Methodology: In the study, 99 men above 40 years with LUTS attending the urology clinics were consecutively enrolled, administered with the IIEF – 5 and assigned an ED status. …

Diagnostic Accuracy Of Hba1c Test In Diagnosis Of Diabetes And Prediabetes In A Multiethnic Population At Aga Khan University Hospital, Nairobi., Francis Kiigu Wathigo

Theses & Dissertations

Introduction: Diabetes mellitus is a metabolic disease characterized by hyperglycaemia secondary to impaired insulin secretion, impaired insulin action or both. In Kenya, an estimated 750,000 people are diabetic with more than 50% estimated to be unaware of their status.

Conventionally, diagnosis has been based on plasma glucose levels. In 2010, Haemoglobin A1c (HbA1c) was approved by the American Diabetes Association (ADA) and World Health Organisation (WHO) for diagnosis of diabetes. However, different studies have shown variations in diagnostic performance of HbA1c.

Research question: What is the diagnostic sensitivity and specificity of HbA1c in diagnosis of diabetes and prediabetes at Aga …

Impact Of Deep Versus Awake Laryngeal Mask Airway Removal On Airway Complications In Spontaneously Breathing Adult Patients Following Isoflurane General Anesthesia., Ronald Ombaka

Theses & Dissertations

Background: The Laryngeal Mask Airway (LMA) is one of several supra-glottic airway management devices used in anaesthesia. The scope of use of the LMA is progressively expanding to areas previously contraindicated, for instance laparoscopy and prone position surgery. Certain aspects of LMA use remain unsettled. Whether to remove the LMA when a patient is “awake” vs “deep” following anaesthesia is one such area. The manufacturer Ambu® recommends that the AuraOnce™ LMA be removed once the patient is fully awake and protective airway reflexes are active. Despite this, several studies have shown benefit in removal of the LMA while a patient …

Association Between Female Sexual Dysfunction And Fertility Among Women Of Reproductive Age At The Aga Khan University Hospital, Nairobi., Felix Mwembi Oindi

Theses & Dissertations

Introduction: Sexual function plays an essential role in the bio-psychosocial wellbeing and quality of life of women and disturbances in sexual functioning often result in significant stress. Sexual dysfunction in women is a highly prevalent condition affecting up to 43% of women. Subfertility being a common problem affecting up to 20% of the population, causes significant psychosocial distress which might adversely affect sexual functioning and vice versa. However, despite the high prevalence of both conditions, little has been studied on the effects of subfertility on sexual functioning especially in sub-Saharan Africa.

Objectives: This study primarily compared the prevalence …

Diagnostic Value Of Complementary Strain Elastography In The Classification Of Breast Masses, Sarah Muthoni Wambui

Theses & Dissertations

Background: Breast cancer is the commonest cancer in women. Ultrasound has a high sensitivity but low specificity in the classification of benign and malignant breast masses. Strain elastography has the potential of increasing the specificity of breast ultrasound in classifying malignant and benign breast masses and reducing the number of benign breast biopsies performed. The diagnostic value of breast elastography in African women is not known.

Objective: The aim of this study was to evaluate the additive diagnostic value of strain elastography to conventional ultrasound in the classification of malignant and benign breast masses in an African population.

Materials …

Prevalence Of Double Myc/Bcl2 Expression And The Cell Of Origin In Diffuse Large B-Cell Lymphomas Diagnosed At A Tertiary Level Referral Laboratory, Jonathan Wawire

Theses & Dissertations

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most commonly diagnosed non-Hodgkin’s lymphoma in adults worldwide. In Kenya DLBCL accounts for 64% of all non-Hodgkin’s lymphomas diagnosed in adults. It is a heterogeneous disease and patients show varying outcomes despite standard treatment. This variability is attributed to the differences in the biology and molecular pathogenesis of DLBCL.

The five most important prognostic factors for DLBCL include scores for the revised international prognostic index (R-IPI), the cell of origin (COO), presence of myelocytomatosis (MYC) and B-cell lymphoma 2 (BCL2) gene rearrangements by fluorescent in situ hybridisation (FISH) or …

Comparison Of Image Quality In High Pitch Free Breathing Versus Standard Pitch Breath-Holding Computed Tomographic Pulmonary Angiography., Kevin Onyinkwa Ombati

Theses & Dissertations

Background: Pulmonary embolism (PE) is the third most common acute cardiovascular disease. Missed diagnosis is responsible for most preventable deaths associated with PE. Artefacts from cardiac and breathing motion are a main pitfall. Advances in Computed Tomographic imaging have enabled rapid imaging in an attempt to overcome these pitfalls.

Objective: To compare image quality when using high pitch free breathing versus standard pitch breath holding Computed Tomographic Pulmonary Angiography (CTPA) using a dual source scanner.

Methods: This was a randomised control trial whereby patients referred to the radiology department for CTPA examination for suspected pulmonary embolism were randomly selected into …

Comparison Of The Sensitivity Of Biomarker Based Matrix Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (Maldi-Tof Ms) And Conventional Methods In The Identification Of Clinically Relevant Bacteria And Yeast, Ali Abdow Kassim

Theses & Dissertations

Background: MALDI-TOF MS is an analytical method that has recently become integral in the identification of microorganisms in clinical laboratories. It relies on databases that majorly employ pattern recognition or fingerprinting. Biomarker based databases have also been developed and there is optimism that these may be superior to pattern recognition based databases. This study compared the performance of ribosomal biomarker based MALDI-TOF MS and conventional methods in the identification of selected bacteria and yeast.

Methodology: The study was a cross sectional study carried out in collaboration with the Swiss Tropical and Public Health Institute, Switzerland and Mabritec laboratory, Riehen, Switzerland. …

Vitamin D Supplementation In Allo-Hsct Patients, Bailey Nelson

Theses & Dissertations

BACKGROUND: Bone health is a serious concern for long-term survivors of Allo-HSCT due to multiple risk factors including steroids, chemotherapy, immunosuppressive drugs, and poor nutrition status1. Steroids have been long proven to have negative impact on bone health and the National Osteoporosis Foundation (NOF) lists steroids as a contributing factor to osteoporosis and fractures. NOF guidelines recommend providing adequate daily vitamin D as a safe and inexpensive way to help reduce fracture risk1. Therefore, proper supplementation of vitamin D may increase the quality of life for patients post Allo-HSCT.

PURPOSE: The purpose of this study is to determine if Allo-HSCT …

Epigenetic Modifications Of Human Placenta Associated With Preterm Birth, Drissa Toure

Theses & Dissertations

Preterm birth is a complex multifactorial process. Despite the well-known role of the placenta in supporting the fetal development and maternal-fetal tolerance, the placental epigenetic modifications and preterm birth (PTB) remains poorly understood and under investigated. Various maternal and environment factors can influence epigenetic programming during fetal development to affect the functioning and structures of organs, including the placenta, which can lead to adverse pregnancy outcomes, including PTB. The understanding of the placental epigenetic alterations and maternal determinants associated with PTB are apparently indispensable for the development of actual diagnosis and methods of prevention and treatment of premature labor. The …

The Rise And Fall Of The Bovine Corpus Luteum, Heather Talbott

Theses & Dissertations

This dissertation describes a study of the mechanisms regulating the genesis and subsequent involution of the temporary endocrine structure, the corpus luteum (CL), through the use of a bovine model. The CL is essential for maintaining a suitable uterine environment for embryo implantation and early development through secretion of the steroid hormone progesterone. The “Rise and Fall” of the CL occurs within each estrous cycle whereby the CL must form from the ruptured follicle, secrete sufficient progesterone for uterine maturation, and at the end of the cycle (or pregnancy) regress to allow new follicular development. During the rise of the …

Effect Of Postprandial Walking On The Glycemic Effect Of A Meal: Type I Diabetes, Samantha L. Hinojosa

Theses & Dissertations

This study was conducted to determine if 15 minutes of postprandial light walking has an effect on the glycemic response to a Boost® beverage in individuals with type 1 diabetes. Seven participants, 22.3 + 4.3 yrs, with type 1 diabetes completed the two days of data collection. On day 1, participants measured baseline fasting blood glucose (BG) with a glucometer, consumed a Boost® beverage, and sat quietly, repeating BG measurements 15, 30, 60, 90, and 120 minute. On day 2, participants repeated the protocol, but walked 15 minutes at a light pace (50-60% max HR) immediately after beverage consumption. The …

Immunohistochemical P21 Expression In Breast Cancer: Association With Patient And Tumour Characteristics, Benjamin N. Njihia

Theses & Dissertations

Introduction: Molecular characterisation of the breast cancer has allowed for targeted therapies that are improving outcomes. The gains achieved by these treatments have fuelled the search for other targets, including cyclin-dependent kinase inhibitors such as p21. p21 expression in breast cancer has been shown to be variably associated with clinical and pathological parameters in different populations. It is possible that either methodological or biological differences underlie these variations.

Objective: The current study sought to determine the association of p21 expression and clinico-pathological parameters in breast cancer patients at the Aga Khan University Hospital in Nairobi, Kenya.

Methods: Clinically annotated tissue …

Prevalence Of Non-Alcoholic Fatty Liver Disease In Overweight And Obese Children Seeking Ambulatory Health Services In Nairobi, Anne Njeri Mburu

Theses & Dissertations

Introduction: Non-alcoholic fatty liver disease is often an asymptomatic condition one of the leading causes of chronic liver disease and is associated with an increase in cardiovascular morbidity. Being overweight or obese has been positively linked to non-alcoholic fatty liver disease in children. There is evidence to show that when detected early, non-alcoholic fatty liver disease is reversible primarily upon institution of lifestyle changes targeted at weight reduction.

Establishing the prevalence of non-alcoholic fatty liver disease in overweight and obese Kenyan children would serve as a benchmark for long term monitoring of associated morbidity and guide in public health policies …