Medicine and Health Sciences Commons^™

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 …

A Randomised Controlled Trial Comparing The Effect Of Adjuvant Intrathecal 2mg Midazolam To 20-Micrograms Fentanyl On Post-Operative Pain For Patients Undergoing Lower Limb Orthopaedic Surgery Under Spinal Anaesthesia, Francis Otieno Codero

Theses & Dissertations

Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. As an intrathecal adjuvant, fentanyl improves the onset and quality of spinal blockade as compared to plain bupivacaine and confers a short duration of postoperative analgesia. However, its use is associated with several adverse effects that range from pruritus to life threatening respiratory depression. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of postoperative analgesia. No studies have been done comparing intrathecal …

A Randomized Control Trial To Assess The Effect Of Aketamineinfusion On Tourniquet Hypertension During General Anaesthesia In Patients Undergoing Upper And Lower Limb Surgery, Joyce Atieno Ongaya

Theses & Dissertations

Background: Tourniquet hypertension arising from tourniquet inflation remains of primary concern to the anaesthetist. One drug commonly used to manage tourniquet hypertension is ketamine. Several studies show that ketamine attenuated the blood pressure rise associated with tourniquet inflation. None of the studies carried out examined the effect of ketamine on tourniquet hypertension for a period of more than one hour or an infusion of the same.

Objective: To compare the effect of an intravenous infusion of ketamine, versus placebo on tourniquet induced hypertension in patients undergoing upper and lower limb surgery under general anaesthesia

Study design: Single blinded Randomized …

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 …

Validation Of The Ottawa Ankle Rules At A Tertiary Teaching Hospital: A Cross-Sectional Study, Mark Karanja Tharao

Theses & Dissertations

Introduction: Ankle joint and foot injuries are among the commonest injuries seen at the Accident and Emergency Department of any hospital. Within the United States it is the second most common musculoskeletal injury seen by physicians. Assessment of these injuries is done clinically and when deemed necessary a radiograph is requested. Studies have shown that radiographs are ordered in over 95% of cases yet the prevalence of fractures is in the range of 15-20%. This means that more than 80% of patients are exposed to unnecessary radiation. The Ottawa ankle rules have been designed to reduce the need for performing …

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 …

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 …

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 …

Expression Of Mismatch Repair Proteins In Colorectal Cancer At Aga Khan University Hospital, Nairobi, Charles M. Wahome

Theses & Dissertations

Introduction: Microsatellite instability is one of three molecular pathways described in the pathogenesis of colorectal carcinoma. The presence of microsatellite instability in patients with colorectal cancer has implications for prognosis and family counselling. Deficiency in mismatch repair genes leads to microsatellite instability and this can be reliably demonstrated in formalin fixed paraffin embedded tissue by methods, which include immunohistochemistry for the detection of mismatch repair proteins.

Local data show a disproportionately large number of younger patients with colorectal cancer compared to that documented in Caucasians. Colorectal cancer in younger ages is often attributed to deficient mismatch repair.

The objective of …

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 Vitamin D Deficiency In An Ethnic African Urban Obstetric Population In An Equatorial City Hospital, Raj Hasmukh Dodia

Theses & Dissertations

Introduction: Low Vitamin D levels in pregnancy have been associated with an increased risk of gestational diabetes, pre-eclampsia, bacterial vaginosis, preterm birth, disordered fetal skeletal homeostasis, and impaired offspring lung health. As a result, current public health advice in several countries is to universally supplement Vitamin D during pregnancy. Data regarding the Vitamin D levels of the ethnic obstetric population in Kenya are not available; hence recommendations for Vitamin D supplementation have no scientific basis.

Objectives of study: This research was carried out to determine the prevalence of deficiency of Vitamin D in ethnic African obstetric patients who had delivered …

A Randomised Controlled Trial Comparing Haemodynamic Stability In Elderly Patients Undergoing Spinal Anaesthesia At L5,S1 Versus Spinal Anaesthesia At L3,4 At The Aga Khan University Hospital, Nairobi, Karen Nkatha Mbaya

Theses & Dissertations

Background: Spinal anaesthesia is a routinely used anaesthetic technique for elderly patients undergoing operations involving the lower limbs, lower abdomen, pelvis and the perineum. Spinal anaesthesia has several advantages over general anaesthesia and these include stable haemodynamic variables, less blood loss, less post operative pain, faster recovery time and less post operative confusion. However, despite these advantages, the sympathetic blockade induced by spinal anaesthesia can result in hypotension, bradycardia, dysrhythmias and cardiac arrests. Conventionally, spinal anaesthesia is performed at the level of L3,4 interspace; with a reported incidence of hypotension in the elderly ranging between 65% and 69%. A possible …

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 …

A Comparative Study Of The Genotype Mtbdrplus® Assay Against A Standard Culture Method For Diagnosis And Drug Susceptibility Testing Of Tuberculosis, Peris W. Thamaini

Theses & Dissertations

Background: Nearly one-third of the global population, i.e. two billion people, is infected with Mycobacterium tuberculosis and is at risk of developing the disease. More than eight million people develop active tuberculosis (TB) every year, with about two million dying from the disease annually. Diagnosis of tuberculosis inKenya remains dependent on smear microscopy. New methods of TB diagnosis are needed which have better accuracy and are still cost effective. Molecular methods of TB diagnosis have come under investigation in a lot of studies recently. However, they have their own limitations including the inability to differentiate between active organisms and …

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 …

Median Values For Second-Trimester Maternal Serum Αlpha Fetoprotein And Human Chorionic Gonadotrophin (Double Test) At Aga Khan University Hospital-Nairobi, Nancy A. Okinda

Theses & Dissertations

Aim

To establish median values for second trimester maternal serum human chorionic gonadotrophin (HCG) and alpha fetoprotein (AFP) at Aga Khan University Hospital- Nairobi (AKUH-N) using the Abbott Micro particle Enzyme immunoassay.

Specific objectives

•To perform measurements of second trimester maternal serum human chorionic gonadotrophin (HCG) and alpha fetoprotein (AFP) and to establish observed and regressed median values.

•To establish regression coefficients for regressed medians of AFP and HCG.

•To compare these data with data obtained from other geographical regions.

Methodology

330 serum samples from women of gestational ages 15 to 20 weeks were analyzed for AFP and HCG. Observed …

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 …

Evaluating The Diagnostic Performance Of An Initial Transvaginal Sonogram (Tvs) In Patients With Suspected Ectopic Pregnancy, Zablon Bett

Theses & Dissertations

Purpose of the study: To evaluate the diagnostic performance of an initial transvaginal sonogram (TVS) in patients with suspected ectopic pregnancy (EP).

Objectives: 1) To determine the accuracy, sensitivity, specificity, positive and negative predictive values of an initial TVS scan in patients with suspected EP. 2) To determine the diagnostic utility of TVS findings as predictors of EP.

Methodology: This was a descriptive, prospective study of 131 consecutive mothers who had TVS for clinical suspicion of EP at the Aga Khan University hospital over a 12 month period between November 2007 and October 2008. The scans were performed in our …

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 …

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 …

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 …

Utility Of Free To Total Psa Ratio In The Prediction Of Prostate Cancer In Patients With Intermediate Total Psa Levels And Negative Digital Rectal Examination, Muthoni .J .F. Kirimi

Theses & Dissertations

Background: Prostate carcinoma is among the top 5 cancers occurring in Kenyan men. Prostate-specific antigen (PSA) is currently the most important biochemical marker for the diagnosis of prostate cancer and its widespread use as a serum tumor marker has revolutionized the management of patients with prostate cancer. The identification of early prostate cancer is vital in the management of especially men who have mild or vague prostatic symptoms. The most basic and important proxy for determining the need for a biopsy in both symptomatic and asymptomatic(screened) patients is the serum prostatic specific antigen (PSA).If a patients PSA level is above …

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; …

Evaluation Of Suspected Renal Colic Patients With Unenhanced Low-Dose Multidetector Computed Tomography (Mdct), Nebayosi Twahirwa

Theses & Dissertations

Acute renal colic is probably one of the most excruciatingly painful event a person can endure. [1]. Though this is typical of urinary tract calculi, it’s important to note that non-calculus and non-genitourinary conditions can present in a similar manner. Unenhanced helical CT (CT KUB), originally described by Smith et al [2] in 1995, is one single radiological test that has proven successful in the valuation of patients presenting with renal colic. This technique has been shown to be more accurate compared to abdominal radiography [3,4], ultrasound and has replaced excretory urography in the detection of urinary tract calculi in …