Medicine and Health Sciences Commons^™

Association Between Ct Severity Score And Clinical Severity Score Of Covid-19 Pneumonia At Aga Khan University Hospital, Nairobi, Paul Kareithi Nduati

Theses & Dissertations

Background: Imaging with chest computed tomography (CT) has demonstrated a role in stratifying COVID-19 patients into different clinical severity groups thus facilitating appropriate care decisions. In a limited number of settings, the wider applicability and reproducibility of these findings is unclear.

Objectives: To determine the association between chest CT severity score and clinical severity of illness in RT-PCR confirmed SARS-CoV2 patients. To evaluate the relationship of CT chest severity score with short term clinical outcome of patients.

Methods: CT chest of 172 SARS-CoV2 patients who accessed care at Aga Khan University Hospital Nairobi between 14th March and 31st December 2020 …

Diagnostic Accuracy Of Axillary Ultrasound In Predicting Nodal Metastasis Among Patients With Early Breast Cancer At Aga Khan University Hospital, Nairobi, David Mwaniki

Theses & Dissertations

With emerging evidence showing that the incidence of breast cancer in Kenya is increasing, there is renewed emphasis on screening, early detection, and management of breast cancer. Early breast cancer (EBC) has a better prognosis and is potentially curable. Axillary nodal metastasis is an important prognostic indicator in breast cancer. Axillary ultrasound is the best modality for assessing, and managing, the affected nodes. It is a readily available and versatile tool with several sonographic nodal characteristics suggestive of metastatic involvement having been described in previous studies. Axillary ultrasound (AUS) performance in predicting nodal metastasis has yielded variable results which are …

Optimal Fasting Duration To Effectively Suppress Physiological 18f- Fluorodeoxyglucose (Fdg) Myocardial Uptake On A Positron Emission Tomography Scan., Fatima Abdullahi Ali

Theses & Dissertations

Background: Positron emission tomography (PET) with 18F fluorodeoxyglucose (FDG) is used in evaluation of inflammatory disorders, including the heart such as cardiac sarcoidosis and myocarditis. However, the normal uptake of the myocardium is a challenge as it can obscure pathological uptake in these conditions. The primary objective of this study is to determine the optimal fasting duration to suppress physiological myocardial uptake and thereafter establish an imaging protocol.

Methods: Patients who had whole body FDG PET CT examination for oncological evaluation at the Aga Khan University Hospital between January 2019 and December 2020 were retrospectively reviewed. Patients were divided into …

Radiological Comparison Of Tumour Burden Of Lymphoma In Hiv Positive And Hiv Negative Patients, Poonamjeet Kaur Loyal

Theses & Dissertations

Introduction: Patients with Human Immunodeficiency Virus (HIV) are known to exhibit atypical pattern of lymphoma on imaging. There is paucity of literature on differences in tumour volume or burden of disease amongst HIV positive patients compared with HIV negative patients and how this correlates with clinicopathological parameters of aggressiveness and effects on prognosis.

Objective: The purpose of this study was to evaluate the tumour burden of non-Hodgkin’s lymphoma in HIV positive patients compared with HIV negative and how this correlates with the clinicopathological parameters of aggressiveness and the overall clinical outcome.

Methods: This was a retrospective analytical cross-sectional study. All …

Compliance To Imaging Follow Up Recommendations Among Patients With Bi-Rads 3 Breast Lesions, Florence Thuita

Theses & Dissertations

Background: The Breast Imaging Reporting and Data System 3 (BI-RADS 3) category is assigned to lesions which are deemed to be probably benign on breast imaging with a low likelihood of malignancy (≤2%). With regular imaging follow-up, this category is intended to reduce the rate of invasive biopsies while enabling early detection of breast cancer. However, imaging follow-up has been reported to be challenging to both radiologists and referring clinicians in terms of its appropriate use on the various imaging modalities and understanding management of the patients in this category. Furthermore, it has been reported to induce patient anxiety …

Radiographic Patterns Of Different Aetiologies Of Community Acquired Pneumonia In Patients Presenting To Aga Khan University, Hanika Ajaykumar Patel

Theses & Dissertations

Background: Community-acquired pneumonia (CAP) is a major cause of significant morbidity and mortality globally. The spectrum of causative organisms of CAP varies markedly with region as well as with the immune status of the patient. Chest radiography remains an important initial imaging modality in the diagnostic work-up of patients with CAP. Although previous studies have highlighted major trends and radiographic patterns of various causative organisms of CAP, there is a paucity of recent literature within Sub-Saharan Africa on these various radiographic patterns.

Objective: The primary objective of this study was to identify the association between the radiographic patterns of different …

Prior Mammographic Screening: What Is Its Effect On The Clinical Stage In Newly Diagnosed Breast Cancer Patients At Akuhn., Jillo Bika

Theses & Dissertations

Introduction: Breast cancer is now the leading cancer amongst women in Kenya according to GLOBOCAN 2018. It is also a leading cause of cancer deaths in Kenya, after esophageal and cervical cancer. Mammography is the gold standard in the screening of breast cancer. For screening to be effective, however, it has to be offered to the right patients at the appropriate time and intervals. Up until February of 2019, there were no local guidelines to guide the screening of breast cancer in Kenya. The objective of this study is to assess if prior mammographic screening had an effect on the …

Discordance Between Breast Imaging And Histopathology Findings After Ultrasound Guided Core Needle Biopsy, Margaret Mutinda Mwania

Theses & Dissertations

Introduction: Breast cancer is the most prevalent cancer among women worldwide with an estimated global incidence of 11.6%. According to the GLOBOCAN factsheet, in 2018 breast cancer incidence in Kenya was 40.3 per 100,000. Early detection and diagnosis of breast cancer has been shown to reduce mortality and increase years of life gained. Breast lesion diagnosis is heavily based on imaging and pathology and typically findings are reported independent of one another. Correlation of imaging findings and pathology after biopsy is found to be of critical importance in detecting possible sampling error, concordance versus discordance, recommend appropriate management and thus …

Human Immunodeficiency Virus Theranostics, Christopher J. Woldstad

Theses & Dissertations

RATIONALE: Long-acting slow effective release antiretroviral therapy (LASER ART) was developed to improve patient regimen adherence, prevent new infections, and facilitate drug delivery to human immunodeficiency virus cell and tissue reservoirs. However, maintenance of sustained plasma drug levels, for weeks or months, after a single high-level dosing, could improve regimen adherence but, at the same time, affect systemic toxicities. Of these, the most troubling are those that affect the central nervous system (CNS) In an effort to facilitate LASER ART development, “multimodal imaging theranostic nanoprobes” were created. These allow combined bioimaging, drug pharmacokinetics and tissue biodistribution tests in animal …

Diagnostic Accuracy Of Multi-Parametric Mri In Diagnosis Of Clinically Significant Prostate Cancer, Mariah Obino

Theses & Dissertations

Background: Traditionally, the diagnosis of prostate cancer has been based on an elevated prostate specific antigen or an abnormal digital rectal examination and confirmed histologically following prostate biopsy. This has led to a number of men without cancer or with clinically insignificant disease undergoing unwarranted prostate biopsies and suffering consequent complications. Pre-biopsy multi-parametric MRI plays a vital role in determining men with clinically significant cancer who need biopsy and those with a negative MRI who can safely avoid an unwarranted biopsy. Whereas studies on the value of multi-parametric MRI have been done elsewhere, there is variation in prevalence of prostate …

Prevalence Of Suspicious Mammographic Calcification In Newly Diagnosed Breast Cancer Patients At The Aga Khan University Hospital, Nairobi., Mariam Abdullahi Omar

Theses & Dissertations

Introduction: The most common cancer affecting women in Kenya is breast cancer with an incidence of 40.3 per 100 000 at risk population in 2018(1) while Nairobi has a higher incidence of (ASR 51.7 per 100,000) (2).This constitutes a major public health problem so early diagnosis plays a major role in mortality reduction and improving prognosis of breast cancer(3). Mammography is the most sensitive technique for detecting non palpable lesions. Over the decades it has been shown that in the USA there has been significant reduction in breast cancer mortality by 40% due to screening mammogram (4). On mammography the …

Changes In The Transverse Dimension Of The Nasomaxillary Complex Following Rapid Palatal Expansion – A Post-Retention, Cbct Evaluation, Allison Schubert

Theses & Dissertations

Purpose: The purpose of this investigation was to evaluate the immediate and long-term effects of palatal expansion on the transverse dimension of the nasomaxillary complex.

Materials and Methods: Twenty-eight patients’ CBCTs were obtained at four time points: pre-expansion (T₁), post-expansion (T₂), pre-treatment (T₃), and middle or end of orthodontic treatment (T₄). The patients’ age, sex, cervical vertebral maturation stage, and the number of instructed expander turns were recorded. Measurements of the nasal floor, nasal passage, maxillary sinus, maxillary first molar mesiolingual cusp, maxillary first molar palatal cusp, maxillary first molar buccal cortical …

Prevalence Of Metastatic Disease In Newly Diagnosed Breast Cancer Patients As Seen On Contrast Enhanced Computed Tomography Of The Chest, Abdomen And Pelvis At The Aga Khan University Hospital, Nairobi., Gregory Obala

Theses & Dissertations

Introduction: Breast cancer patients have traditionally been screened for occult metastases with abdominal ultrasound, chest radiography and bone scan although the use of modern tests with greateraccuracy such as computed tomography (CT), 2-[fluorine-18] fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) and Magnetic resonance (MR) imaging is on the increase. The use of contrast enhanced CT (CECT) in the staging of patients with newly diagnosed breast cancer has increased greatly in clinical practice in view of it being widely available and relatively cheapwhen compared to other modalities such as MRI and PET imaging. The clinical utility of routine staging CECT is …

Determining The Level Of Agreement For Atherosclerotic Cardiovascular Disease Risk Stratification Between Coronary Artery Calcium Score And Traditional Cardiovascular Risk Models., Menge Kuria

Theses & Dissertations

Introduction: Estimating the risk of future cardiovascular (CV) events is an essential step in the management and prevention of cardiovascular diseases. Many cardiovascular risk tools are available such as the Framingham Risk Score (FRS), the American Heart Association/ American College of Cardiology (AHA/ACC) and the International Society of Hypertension and World Health Organization (ISH/WHO) risk charts. Regrettably, none of these tools has yet to be validated based on data from our Kenyan population. This study, therefore, sought to compare the accuracy of FRS and ACC/AHA in a Kenyan population. The risk estimates derived from the CV tools were correlated with …

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 …

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 …

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 …

Prevalence Of Hepatic Steatosis As Diagnosed On Unenhanced Abdominal Ct, Naushad H. Karim Sokwalla

Theses & Dissertations

Background: Hepatic steatosis is the accumulation of triglycerides within hepatocytes. It may be broadly classified into alcoholic and non-alcoholic fatty liver disease, whereby non-alcoholic fatty liver disease is steatosis secondary to causes such as steatogenic medication. Liver biopsy remains the gold standard for diagnosis of hepatic steatosis. However, it is invasive and may potentially suffer from sampling errors. Hepatic steatosis may be diagnosed on unenhanced CT if the hepatic attenuation is less than 40 HU, or if the attenuation of the liver is at least 10 HU less than the spleen. Over the past three decades, non-alcoholic fatty liver disease …

Sonographic Estimation Of The Prevalence Of Hepatic Steatosis In Hiv Monoinfected Patients At Aga Khan University Nairobi., Bernadette Wambui Muthee

Theses & Dissertations

Introduction: Human immunodeficiency virus disease (HIV) is a worldwide health problem. It is estimated that 38.6 million people are infected with HIV globally. It has remained endemic in the African continent for close to 20 years and is a long term developmental challenge in Africa which bears 69 % of the HIV/AIDS global burden.

The introduction of highly active antiretroviral therapy (HAART) has caused dramatic improvement in prognosis of HIV disease. Consequently, this has resulted in substantial reduction in Acquired Immune Deficiency Syndrome (AIDS) related morbidity and mortality. In contrast, this has been accompanied by an upsurge in liver- related …

Ultrasound Evaluation Of Umbilical Coiling Index In Second Trimester Of Gestation And Its Association With Small For Gestational Age Status At Birth, Josephine Mwikali Ndolo

Theses & Dissertations

Introduction: The degree of coiling of the umbilical cord, referred to as umbilical coiling index, has been shown to have an effect on perinatal adverse outcomes such as small for gestational age neonates, interventional delivery, meconium staining, low fetal pH and low Apgar score. This study proposes that the antenatal umbilical coiling index performed in the second trimester of pregnancy has a correlation with the gestation-specific birth weight and can therefore be used as a marker to predict small for gestational age neonates.

Objective: To determine the association between antenatal umbilical coiling index (aUCI) in the second trimester and small …

Comparison Of Quantitative Analysis To Qualitative Analysis For Interpretation Of Lower Limb Lymphoscintigraphy, Edward Chege Nganga

Theses & Dissertations

Background: Lymphoscintigraphy is now the primary imaging modality used in determining a diagnosis in patients with suspected extremity lymphedema. However, analysis is mainly by visual qualitative analysis which is subjective and has a wide inter-observer variability. Subtle differences in ilioinguinal uptake between normal and abnormal limbs may be missed with visual qualitative analysis. This study seeks to compare quantitative analysis to qualitative analysis by computing percentage ilioinguinal nodes uptake at 1.5 hours.

Objectives: To compare quantitative analysis to qualitative analysis of lower limb lymphoscintigraphy in the diagnosis of lymphedema.

To determine the diagnostic accuracy of quantitative lymphoscintigraphy analysis.

Methodology: 52 …

Prevalence Of Suspicious Ultrasound Findings In Patients With Mammographic Focal Asymmetry At Aga Khan University Hospital, Nairobi, Jacqueline Ndunge Mavuti

Theses & Dissertations

Background: Breast cancer has become the leading cancer in women in both economically developed and developing countries, accounting for 25% of all cancers diagnosed worldwide in 2012. The cornerstone of breast cancer control remains early detection in order to improve outcomes and survival. Thus far the only breast cancer screening method that has proved to be effective is mammography. Although mammography is the mainstay of early detection, a fundamental limitation is its low inherent contrast difference between the soft tissue structures in the breast. Mammographic specificity relies on the ability to distinguish benign from malignant breast lesions based on their …

Prevalence Of Significant Liver Fibrosis In Patients With Hiv Monoinfection Compared To Those With Hiv-Hepatitis B Coinfection As Assessed By Shear Wave Elastography, Samuel Nguku

Theses & Dissertations

Background: Liver disease is an emerging management problem in human immunodeficiency virus (HIV) infected patients. The incidence of chronic Hepatitis B infection, which accelerates the progression of chronic liver disease and development of liver fibrosis, is ten times higher in patients with HIV than the general population. Staging of liver fibrosis provides essential information in management of these patients.

Objective: To determine the prevalence of significant liver fibrosis in patients with HIV mono-infection versus those with HIV-HBV co-infection as assessed with shear wave elastography (SWE).

Methods: This was a cross-sectional study whereby HIV infected patients attending the HIV clinic at …

Prediction Of Breast Tumor Size By Ultrasound: A Comparison With Pathology, David Toyis Wanyonyi

Theses & Dissertations

Background: Tumor size is one of the most important prognostic factors in breast cancer and its accurate assessment is critical in planning appropriate treatment. Although histology is often regarded as the definitive way of establishing tumor size, radiological techniques, particularly ultrasonography, are usually relied upon to give an estimate of the tumor size for prognostication and treatment planning. Correlations between mammography, ultrasonography, magnetic resonance imaging (MRI) and pathology size have been performed in different populations with varying results however no prospective study has been done to establish the agreement between sonographic tumor size and histopathological tumor size in our …

The Utility Of A Tablet Computer Device In Comparison To A Standard High Resolution Monitor For Reporting Ct Kub Images, Kenneth Kiriinya Ibeere

Theses & Dissertations

Background: The latest technological developments in the field of digital medical imaging have facilitated the transfer of the power and utility of the personal computer to mobile computing devices. One of these that have been used in diagnostic imaging is a tablet computer. Mobile tele-radiology using a tablet computer device is an apt extension of imaging services, for after-office-hours consultation. It is crucial to determine the diagnostic accuracy of these portable computer devices in order to determine safety for use in diagnostic image interpretation without compromising patient care.

Objective: To find out the diagnostic accuracy of urolithiasis (urinary tract calculi) …

Prostate Specific Antigen As A Risk Factor For Skeletal Metastases In Black African Men With Prostate Cancer, Ayman Mahmood Qureshi

Theses & Dissertations

Background: Prostate cancer is one of the commonest cancers in men worldwide. Several recognised risk factors are associated with this disease, amongst them, race. Despite this, there is a paucity of data in the native African setting. The skeletal system is a common site of metastasis, its incidence increasing with increase in prostate specific antigen (PSA) levels. Bone scans are used to detect skeletal metastases. Its use in prostate cancer patients with abnormal but low PSA has been subject of debate.

Objectives: To test the association of PSA levels with skeletal metastasis in men with histologically proven prostate …

Uterine Fibroid Embolization For Symptomatic Fibroids; Correlation Of Mid-Term Changes In Disease-Specific Symptoms And Magnetic Resonance Imaging Results At A Teaching Hospital In Kenya, John Kiprop Mutai

Theses & Dissertations

Background: Uterine fibroid embolization, though a widely available option in high income countries in managing symptomatic fibroids is relatively new in the East African region. It is currently offered at only one tertiary facility for the past three years. The symptom and radiological response in these patients, who literature suggests may have bigger fibroid burden and worse symptoms, is the subject of this study.

Objective: Characterization of MRI imaging features in women undergoing uterine fibroid embolization and identification of clinical correlates in an African population.

Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed …

The Role Of Inflammation In Contrast Induced Nephropathy, Elijah A. Kwasa

Theses & Dissertations

Background: Intravenously administered iodinated contrast media are widely and liberally used in daily diagnostic radiological investigations. Contrast-induced nephropathy (CIN) is notable as the third commonest cause of hospital-acquired renal injury.

Justification: The global prevalence of CIN from various studies ranges from 2-5% but an incidence of CIN of 12-14% in Kenya was highlighted by a recent study without an explanation for the markedly increased incidence. Intravascular contrast has been demonstrated to commonly cause renal vasoconstriction. However, the low incidence of CIN in the general population infers that contrast alone cannot be a causative insult. This study proposes that inflammatory …

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 …