Medicine and Health Sciences Commons^™

Development, Validation, And Diagnostic Performance Of A Novel Radiomic Model For Predicting Prostate Cancer Recurrence, Linda M. Huynh

Theses & Dissertations

Multi-parametric magnetic resonance imaging (MP-MRI)-derived radiomics have been shown to capture sub-visual patterns for the quantitative characterization of prostate cancer (PC) phenotypes. The present dissertation seeks to develop, evaluate, and compare the performance of an MRI-derived radiomic model for the prediction of PC recurrence following definitive treatment with radical prostatectomy (RP).

MP-MRI was obtained from 339 patients who had a minimum of 2 years follow-up following RP at three institutions. The prostate was manually delineated as the region of interest and 924 radiomic features were extracted. All features were evaluated for stability via intraclass correlation coefficient (ICC) and image normalization …

The Prevalence Of Stress And Stressors Among Pediatric Oncology Nurses Working In Pediatric Oncology Units In Pakistan - An Analytical Cross-Sectional Study, Shenila Anwarali

Theses & Dissertations

Introduction: Pediatric oncology nurses in Pakistan are at the forefront of caring for young cancer patients. In Pakistan, thousands of children are diagnosed with cancer every year, however the country's healthcare system lacks a comprehensive National cancer registry. Pediatric oncology nurses face high stress levels due to the demanding nature of their work, lack of specialized training, and communication challenges with patients and families. This study aims to explore the prevalence of stress and its predictors among these nurses in Pakistan, addressing a significant research gap.
Purpose: The purpose for the study was to measure stress and identify its predictors …

Evaluating The Symptoms And Treatment-Related Knowledge Of Cancer Patients Receiving Chemotherapy In A Tertiary Care Hospital, Kiran Nawaz Ali

Theses & Dissertations

Background: Cancer has become the leading source of mortality and morbidity worldwide. Its prevalence is rising and high-risk behaviours are being adopted by the people in society. Knowledge about cancer and its management helps in adjusting the resource allocations and in terms of public health policy. Moreover, patient education about symptoms, treatment, and side effects is crucial and must be addressed.
Knowledge about cancer, its side effects, and the possible treatment outcomes is essential, as it helps in deciding about adherence to the treatment. It is observed that many oncology patients have information gaps related to cancer and chemotherapy. However, …

Assessing Medication Compliance And The Usage Of Complementary Therapies Effecting Hba1c Among Patients With Type 2 Diabetes Mellitus In A Tertiary Care Hospital In Karachi, Pakistan, Neelam Nasruddin

Theses & Dissertations

Background: Diabetes Mellitus is a chronic illness. It remains to be a major public health matter and a financial burden on the medical system worldwide. This condition can be managed and better treatment strategies and compliance can reduce the risk of complications. In 2022, there will be around 33,000,000 new cases of diabetes worldwide, with 26.7% of the adults in Pakistan being affected, predicts the (International Diabetes Federation, 2022). However, it is observed that most individuals turn to complementary and alternative methods (CAM)/Traditional medicine because of the rising cost of therapy, adverse effects of anti-diabetic medications, and accessibility concerns.
Purpose: …

Using Simulation To Assess Knowledge And Attitude Amongst Healthcare Provider Regarding Cardiopulmonary Resuscitation At A Tertiary Care Hospital In Karachi, Pakistan- A Pre And Post Test Qausi Experimental Study, Nausheen Barkat Ali Noorani

Theses & Dissertations

No abstract provided.

Prevalence Of Type A And Type B Personality Among Undergraduate Nursing Students At Private School Of Nursing Karachi Pakistan: A Cross-Sectional Analytical Study, Farhana Shaheen

Theses & Dissertations

Background: Academic institutions strive for exceptional graduates. However, personality and learning psychology affect student performance. Type A personality students may develop heart palpitations due to impatience and stress. They are less sociable than Type B personalities but more idealistic, competitive, and deadline oriented. These disparities among personalities may impair their academic and job success, especially in healthcare, where interpersonal skills are vital.
Aims: The primary aim of the study was to find out the prevalence of Type A and Type B personality among undergraduate nursing students and to find the association between personality Types and academic years.
Methodology: In this …

A Mixed Methodological Approach To Study The Feasibility Of An End-Of-Life Care Pathway, Noureen Azizullah Mistry

Theses & Dissertations

Background: The growing significance of end-of-life care in response to the increasing prevalence of chronic illnesses and aging populations has prompted recognition of the need for patient-centred care. Care pathways are employed worldwide to offer comprehensive end-of-life care to patients in various healthcare settings. In Pakistan, there is a recognised need to evaluate the feasibility of introducing an end-of-life care pathway.
Objectives: This study aimed to (a) determine the feasibility of using an end-of-life care pathway for hospital-based and home-based palliative care patients, and (b) explore the experiences and opinions of registered nurses piloting the pathway.
Methods: An explanatory sequential …

Comparison Of Physical Activity Levels Among School-Age Adolescents In The Rural And Urban Areas Of District Swat Kpk, Pakistan- An Analytical Cross-Sectional Study, Imran Uddin

Theses & Dissertations

Background: Obesity and overweight represent significant global public health concerns. Young adolescents are in particular increasingly experiencing obesity and overweight due to their sedentary lifestyles, excessive electronic media use, and lack of physical activity (PA). This trend is linked to the development of non-communicable diseases in later life. Moreover, data regarding the lack of PA is available in Pakistan, but a gap exists in the comparative analysis of physical activity levels between rural and urban adolescents. Rural and urban areas exhibit distinctions in both geographical settings and technological advancements, potentially influencing the PA levels of their respective inhabitants.
Purpose: The …

The Knowledge, Experiences, And Barriers Associated With Male Involvement In Family Planning At Lal Qila, District Dir (Lower), Kpk, Pakistan: A Descriptive Exploratory Study, Jalal Khan

Theses & Dissertations

Background: Pakistan is one of the world’s most populous countries with a high growth rate. The overgrowth in population negatively affects the country’s socioeconomic progress in many aspects, like education, housing, employment, and health. Family Planning (FP) is the best way to reduce the fertility rate and control population overgrowth through contraception. FP positively impacts the mother's health and the productive results of every pregnancy.
Purpose: This study aims to explore the knowledge, experiences, and barriers associated with male involvement in family planning.
Method: A qualitative exploratory design was used with a purposive sampling technique to explore the perceptions of …

Concept Of Health-Related Quality Of Life Among People With Heart Failure In Karachi, Pakistan, Anny Ashiq Ali

Theses & Dissertations

Background: Non-communicable diseases (NCDs), including cardiovascular diseases, are a leading cause of global mortality. The mortality rate for cardiovascular diseases is on the rise, with 80 % to 86 % of fatalities, particularly in low- and middle-income countries, including Pakistan. Among NCDs, heart failure (HF) is a condition for which there is no cure, and patients rely on supportive treatments to maintain their quality of life. HF not only affects physical well-being but also has far-reaching consequences on the emotional, social, and cognitive aspects of life. In the context of Pakistan, where unique healthcare, sociocultural, and economic factors prevail, the …

The Efficacy Of Analgesic Subdissociative Dose Ketamine In Trauma Casualties Treated By U.S. Military Special Operations Medical Professionals In A Prehospital Environment, Darin Schwartz

Theses & Dissertations

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty …

Evaluating The Impact Of Routine Enteral Iron Fortification On Gastrointestinal Dysbiosis In Premature Infants, Matthew Van Ormer

Theses & Dissertations

The gastrointestinal microbiome in preterm infants bears significant influence on optimal outcomes – dysbiosis is shown to substantially increase the risk of the life-threatening necrotizing enterocolitis, whereas optimal microbiome composition improves nutrient digestion and immune function. Iron is a vital nutrient especially during the perinatal window of rapid hemoglobin production, tissue growth, and foundational neurological development. However, excess colonic iron exhibits potent oxidation capacity and alters the competitive environment of microbes – potentially facilitating the proliferation of pathological bacterial strains in the gut. Of note, breastfed preterm infants routinely receive iron fortification starting at 14 days of life and are …

Use Of Pre-Transplant Cmi To Predict Infection And Mortality Post-Cardiac Transplantmortality Post-Cardiac Transplant, Chetaj A. Mahabir

Theses & Dissertations

This paper discusses a study investigating the relationship between the cell-mediated immunity (CMI) level before cardiac transplant and the incidence of infection and mortality after the transplant. CMI is an important measure of a person's immune system. The study included 126 patients who underwent cardiac transplants between September 2011 and January 2020. Out of these, 21 patients had a low CMI level (<225), and 105 had a high CMI level (≥ 225) before transplant. The mean CMI level in the low CMI group was 175.3, while in the high CMI group, it was 479.9. The two groups were similar except for the lower white cell count and cardiac output in the CMI< 225 groups and the higher Caucasian demographic in the CMI≥ 225 groups. The study concludes that patients with lower CMI levels before cardiac transplant have a higher risk of infection (p=0.052) and mortality (p=0.005) one year after the transplant. The risk of dying for patients with CMI <225 is 12.9 times the risk of dying for patients with CMI ≥ 225 after adjusting for the other covariates in the model. However, this study has some limitations including its retrospective nature, small sample size, and single-center design. Further studies are needed to replicate these findings and investigate the optimal immunosuppressive regimens based on baseline CMI levels.

The Distribution Of Cardiovascular Risk Factors And The Association With Cadre Amongst Healthcare Workers At A Tertiary University Hospital In Nairobi City, Kenya, Emma Andrea Khabure

Theses & Dissertations

Introduction: According to the World Health Organization (WHO), non-communicable diseases such as stroke, contribute to about 70% of the top ten causes of mortality in the world. The growing burden of Cardiovascular (CVD) risk factors has also been noted to affect the health workforce. According to the Ministry of Health in Kenya employing the WHO STEPS survey, 27% of Kenyans are either overweight or obese. Few studies have been done in Kenya to highlight the prevalence and impact of cardiovascular risk factors amongst healthcare workers. The variety of findings and paucity of data bring about the need to evaluate this …

Functional Status Among Patients With Established Copd Attending Tertiary Hospitals In Dar Es Salaam, Tanzania, Peter M. Tumbo

Theses & Dissertations

Background

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable non communicable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development. It is associated with a lot of risk factors such as smoking, biomass fuel use for cooking and air pollutants in general.

Objectives

The primary objective of this research was to determine the functional status of patients with COPD. The secondary objectives were to determine the factors influencing …

Breast Cancer Molecular Subtype Classification According To Immunohistochemistry Markers And Its Association With Pathological Characteristics Among Women Attending Tertiary Hospitals In Tanzania., Allyzain Ismail

Theses & Dissertations

Background:

Breast cancer immunohistochemistry is a biological characteristic of the tumour which has a role to diagnose molecular subtype, prognosticate and guide treatment and categorised into 4 subtypes, Luminal A, Luminal B, Human Epidermal Growth Factor Receptor 2 (HER2) enriched and Triple Negative Breast Cancer (TNBC).

Objectives:

To determine the prevalence of each molecular subtype of breast cancer and determine their association with pathological and demographic characteristics.

Methods:

A retrospective cross-sectional study was carried out at two tertiary referral hospitals on participants who were recruited from the cancer registries from 2015-2022 and had a breast tissue biopsy confirming primary breast …

Barriers Of Iucd Uptake Among Sexually Active Nulliparous University Students In Dar Es Salaam Tanzania, Fatma Shaib Mohamed

Theses & Dissertations

Background

Family planning contributes an important role in prevention of unintended pregnancy, unsafe abortion, maternal and child mortality. One of the methods used is an IUCD that help in preventing unintended pregnancy. Un intended pregnancy is a public he alth concern worldwide among younger women, resulting into unsafe abortion. Preventing unintended pregnancies in youth is crucial yet challenging. Few studies have addressed the problem of the low utilization of IUCD among university students. This group is overwhelmed with physiological, social, and economic issues in relation to reproductive health especially on family planning accessibility and use. Gap of knowledge and skills …

Experiences Of Diverse Health Care Workers’ Providing Maternal Care During The Covid-19 Pandemic: A Qualitative Study At Five Hospitals In Dar Es Salaam, Tanzania., Fatma Zahran

Theses & Dissertations

Background

There are drastic changes in patient care with respect to maternity due to the COVID-19 pandemic with negative impact to health care workers. With Interruption of everyday basic services, arose the need to redistribute the scanty health care workers across health care facilities in sub-Saharan Africa. Its effects and involvement on maternity practice in Sub-Saharan Africa are nevertheless to be analyzed. This study aims to explore the likely ramifications for obstetrics and gynecologic practice in Tanzania. At present there are limited studies looking at impacts of COVID-19 in sub-Saharan Africa and Tanzania. No study has been carried out to …

Relationship Between Crown Like Structures And Body Mass Index In Breast Cancer, Sophie Wanjiru Irungu

Theses & Dissertations

Introduction: Breast cancer (BC) is the most common malignancy in women worldwide, including Kenya. Globally, increasing incidences of BC have paralleled those of obesity. The mechanism by which obesity contributes to BC is still an active area of research but white adipose tissue inflammation characterized by crown-like structures (CLS), which are macrophages surrounding dying adipocytes, is considered an important contributor.

Objectives: The primary objective was to determine the association between CLS and body mass index (BMI) in BC patients. The secondary objectives were to determine the association of CLS with BC risk factors specifically, age, menopausal status, subtypes of BC, …

Obstructive Sleep Apnea Syndrome Among Hypertensive Patients At A Tertiary Hospital In Kenya, Salim Abdallah Salim

Theses & Dissertations

Introduction: Obstructive sleep apnea (OSA) is a type of breathing problem during sleep caused by the blockage of the upper airway, which can cause a reduction or complete cessation of airflow. Warning signs of OSA include snoring, night sweats, and high blood pressure. However, there is limited research on the prevalence of OSA in hypertensive patients in sub-Saharan Africa (SSA). This study purposed to elucidate the likelihood and clinical characteristics of OSA among hypertensive patients at a tertiary hospital in Nairobi, Kenya.

Methods: This prospective cross-sectional study occurred at the Aga Khan University Hospital in Nairobi, Kenya. A total of …

Quality Of Life And Sexual Function Of Women With Endometriosis At The Aga Khan University Hospital Nairobi, Edna Mohere Chacha

Theses & Dissertations

Introduction: Endometriosis is a benign, chronic condition that affects up to ten percent of women of childbearing age. It’s marked by the presence of endometrial tissue outside the uterine cavity (Giudice, 2010). It is a health condition with wide-ranging and pervasive sequelae making it a significant health concern requiring appropriate action (Rush & Misajon, 2018). We observed that there was a paucity of data relating to how endometriosis impacted on female sexual function and quality of life in sub-Saharan Africa, Kenya included.

Objectives: The primary goal of this empirical investigation was to determine the quality of life of women who …

Placental Histopathological Changes In Covid-19 And Their Associated Effects On Adverse Pregnancy Outcomes, Eric Mugambi

Theses & Dissertations

Introduction: Coronavirus disease (COVID-19) is a significant cause of morbidity and mortality among pregnant women. Pregnant women infected with SARS-CoV-2 are at a greater risk of pre-eclampsia/eclampsia, non-iatrogenic preterm birth, stillbirth, and small for gestational age infants/fetal growth restriction (SGA/FGR), which share a common placental etiology. Placental histopathological changes attributed to COVID-19 have been demonstrated but there is a knowledge gap in how these changes impact pregnancy outcomes particularly those of placental origin.

Objectives: To investigate if there is an association between placental histopathology (maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute and chronic inflammatory pathology, and other findings …

Factors Associated With Non-Uptake Of Implantable Cardioverter-Defibrillator (Icd) Among Eligible Patients At A Tertiary Hospital In Kenya, Emmanuel Benge Aluoch

Theses & Dissertations

Background: Sudden Cardiac Death (SCD) is a major cause of mortality among patients with cardiovascular disease accounting for about 50% of deaths. Several studies have demonstrated the safety and efficacy of Implantable Cardioverter-Defibrillator (ICD) implantation in both primary and secondary prevention of SCD in at-risk populations. Despite well-publicized guidelines, ICD implantation rates remain low particularly in Africa with a paucity of data regarding factors associated with non-uptake and reasons for implant refusal. The study aimed to characterize these factors and identify reasons for ICD refusal. Understanding these factors and reasons for non-implantation will provide an opportunity to optimize ICD uptake …

Risk Factors And Outcomes Of Acute Kidney Injury Among Covid-19 Patients At A Tertiary Hospital In Kenya, Susan Cheruiyot

Theses & Dissertations

Background: Corona Virus Disease 2019 (COVID-19), a novel infection caused by the SARS-Cov-2 virus, was declared a global pandemic on March 11, 2020. Three years later, 350,000 Kenyans had gotten the infection, with approximately 5,700 reported related deaths. Despite emerging research on the new virus, studies from the African continent on the impact of COVID-19 on the kidneys have been few. Early studies suggest that up to 75% of patients with COVID-19 have a derangement in their kidney function as evidenced by new onset proteinuria and hematuria. That said, the prevalence of acute kidney injury has varied greatly across populations, …

Trends Of Intra-Facility Births Outcomes Before And During Covid-19 Era In Dar Es Salaam, Tanzania, Willbroad Kyejo

Theses & Dissertations

Background

While substantial progress had been made in reducing maternal deaths, there was a risk that the COVID-19 pandemic might have reversed the progress made in maternal and newborn health in the last two decades. As such, maternal and newborn outcomes had been a topic of interest during the pandemic.

Objectives

This study aimed to compare the number of childbirths as an indicator of maternal health service utilization and to assess maternal and newborn outcomes before COVID-19 (2011-2019) and during the COVID-19 pandemic (2020/2021) in 22 health facilities in Dar es Salaam.

Methodology

A retrospective cohort study was conducted at …

Factors Associated With Clinically Significant Hyperbilirubinemia Among Abo-Incompatible Newborns At A Tertiary Care Hospital In Kenya., Wandera Ivy Mwenesi

Theses & Dissertations

Background: ABO incompatibility is one of the most common causes of immune-mediated neonatal jaundice. It occurs in approximately 20-25% of all pregnancies. Literature shows that 60- 80% of newborns will develop physiological jaundice within the first week of life. Globally, the incidence ranges from 10-41%. Early detection of newborns with ABO incompatibility-related jaundice can prevent the incidence of bilirubin-induced neurological dysfunction. Whereas there have been extensive published data on rhesus isoimmunization, very few studies have examined ABO incompatibility and isoimmunization. From the published literature, there has been no known study that has assessed risk factors for developing clinically significant jaundice …

Frailty Determination And Responsiveness In Left Ventricular Assist Devices, Sarah Schroeder

Theses & Dissertations

Frailty, the state of being vulnerable with susceptibility to decreased age-related physical reserve, is found in 56-79% of adults with end-stage HF receiving durable left ventricular assist device (dLVAD) therapy. Frailty increases risk of adverse events, including increased mortality in the dLVAD population, but less is known about depression, quality of life (QOL), cognition and frailty responsiveness. Therefore, we aimed to describe and compare frailty (5-Meter Walk Test, 5MWT), depression (Patient Health Questionnaire-9, PHQ-9), quality of life (EQ5D Visual Analog Scale, EQ-5D VAS) and cognition (Trailmaking B) from pre- to 12-months post-dLVAD We also compared demographics, clinical characteristics, and post-dLVAD …

The Association Of Immune And Genomic Biomarkers And Response To Neoadjuvant Chemotherapy In Breast Cancer Patients At Aga Khan University Hospital Nairobi, Catherine Wairimu Mutahi

Theses & Dissertations

Introduction: Breast Cancer (BC) is the most diagnosed cancer among women worldwide and in Kenya. It is a highly heterogeneous disease requiring patient specific treatment and strategies to monitor response to therapy, especially in the neoadjuvant (NAC) setting. Currently, there are no reliable markers in use that can predict response to chemotherapy among patients receiving NAC. Tumour Infiltrating Lymphocytes (TILs) and Cell free DNA (cfDNA) are biomarkers that could possibly bridge this gap. However, limited studies have been carried out on the African population. With the increasing mortality rates attributable to BC in Sub-Saharan Africa, coupled with the growing preference …

Factors Influencing Uptake Of Human Papilloma Virus (Hpv) Vaccine Among Parents Of Adolescent Girls, Irene Nzisa Martin

Theses & Dissertations

Background: Cervical cancer is one of the most common preventable cancers causing morbidity and mortality in women especially in Sub-Saharan Africa. Three HPV vaccines have been approved for vaccination against HPV globally with Cervarix and Gardasil currently available in Kenya. Despite availability of free HPV vaccination and increased media campaigns the proportion of adolescent girls vaccinated against HPV remains low. Understanding the determinants of HPV vaccine uptake will inform strategies to improve the uptake at Aga Khan University Hospital, Nairobi.

Objectives: The aim was to identify the factors influencing HPV vaccine uptake among parents of adolescent girls. The secondary objective …

Conversion Of Dissertations To Publications At The Aga Khan University Kenya: An Exploratory Study Of Residents Perceptions And Experiences, Brigette Macharia

Theses & Dissertations

Background: The successful completion and submission of a dissertation is a fundamental milestone for many residency programs worldwide. Publication of a dissertation in a peer-reviewed journal makes it more accessible and is impactful within the scientific context. It contributes to the global outlook of total burden of disease, for which significant geographical variation exists. Publication of residents’ research is a convenient surrogate marker for research training and experience. However, the preparation of a manuscript, successful submission and acceptance in a peerreviewed journal is challenging for both residents and their supervisors.

Justification: Aga Khan University (AKU) invests heavily in infrastructure to …