Medicine and Health Sciences Commons^™

Association Between Elevated Third Trimester Maternal Haemoglobin And Neonatal Gestational Age Adjusted Birth Weight, Bob Otieno Achila

Theses & Dissertations

Background: Women tend to have lower haemoglobin compared to men due to menstrual blood losses. This is often compounded by nutritional deficiencies. There is a further drop in haemoglobin during pregnancy due to red cell dilution. Pregnancy itself places a huge demand on maternal iron stores. High haemoglobin may reflect haemoconcentration due to a failure of the normal physiological expansion in plasma volume. Iron excess has also been associated with free-radical damage. In current practice, high maternal haemoglobin in pregnancy is often not given as much attention as anaemia. This study examines the association between high maternal haemoglobin in the …

Effect Of A Voice Recognition System On Paediatric Outpatient Medication Errors, Angela Nyangore Migowa

Theses & Dissertations

Background: Medication errors have potential to cause harm and death; especially children who are three times more vulnerable than adults. Risk of medication errors is higher in out- patient settings due to a stressful work environment with less familiarity of individual patients. This problem in sub-Saharan Africa is however largely undetermined. A Voice Recognition System that converts verbal messages into text and stores it in a database in a retrievable format could impact on reduction of medication errors.

Objectives: The primary objective was to compare medication prescription and dispensing errors in written prescriptions with those from a Voice …

Homelessness: Relationships Between Program Completion At A Transformational Shelter And Mental Illness, Substance Abuse, And Trauma, Richard T. Mccutcheon

Theses & Dissertations

Each and every evening many people do not have a home to return to. Solving the epidemic problem of homelessness is an ongoing pursuit. Analyzing issues related to homelessness will help solve the problem of homelessness for some individuals and families. Data was gathered, prioritized and analyzed to determine correlations and relationships between completion of a transformational shelter’s program and mental illness, substance abuse, and trauma. Demographic variables were assessed as well. A person is more likely to complete the program if they have a substance abuse issue. Females are more likely than males to complete the program. Program completion …

The Impact Of Introduction Of The Canadian Ct – Head Rule On The Use Of Ct-Scan On Minor Head Injury Patients At Aga Khan University Hospital, Nairobi, Ramadhani Omari Abdalla

Theses & Dissertations

Background: Head injury is a common traumatic condition seen in Kenya. Among the head injury patients seen at the Aga Khan University Hospital Nairobi, minor head injury patients are the highest proportion of non–fatal trauma patients. Minor head injury is described as witnessed loss on consciousness, definite amnesia or witnessed disorientation in a patient with a GCS score of 13–15 who has suffered a traumatic event. There has been considerable disagreement about the indication for a Computed Axial Tomography Scan of the Head (CT-head) in the large number of patients clinically classified as minor. The Canadian CT Head Rule was …

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 …

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 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 …

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 …

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 …

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 …

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 …