Medicine and Health Sciences Commons^™

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 …

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.

Neurocognitive Impairment In People Living With Human Immunodeficiency Virus (Hiv): Risk Factors And Mortality, Zaeema Naveed

Theses & Dissertations

Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH) with clinical and public health implications. Studies have generated inconsistent results regarding etiological factors for NCI in PLWH and a brief user-friendly predictive tool is desirable in clinical practice to assess the probability of having NCI in PLWH. Furthermore, factors associated with clinically meaningful decline in neurocognitive status and survival disadvantage for patients with NCI are understudied in the post-cART era. The goal of this dissertation was to investigate factors associated with baseline NCI and neurocognitive decline and the association …

Investigating The Relationship Between Unavoidable, Hospital Acquired Pressure Injury And Mortality: Is Unavoidable, Hospital Acquired Pressure Injury A Signal Of Increased One-Year Mortality Risk?, Eileen Jimenez

Theses & Dissertations

The purpose of this dissertation was to explore the strength of the relationship between unavoidable Hospital Acquired Pressure Injury (HAPI) and increased risk of one-year mortality for patients age 55 and older who were admitted to a hospital from 2015 to 2018. A quantitative, retrospective case-control study was designed to compare demographics, comorbid conditions, pressure injury risk, and living situation of those patients that developed unavoidable HAPI and hospitalized adults with similar physiological burdens that remained injury-free. The one-year mortality for the HAPI group was 27 of 48 (56%), and 26 of 47 patients (55%) for the Control group. The …

Integrating Geriatric Assessment And Genetic Profiling To Personalize Therapy Selection In Older Adults With Acute Myeloid, Vijaya R. Bhatt

Theses & Dissertations

Integrating geriatric assessment for patient profiling and genetic profiling of leukemic cells represents an innovative approach to personalize therapy selection in older adults with acute myeloid leukemia (AML). We report results of a pre-planned interim analysis of a pragmatic phase II trial that utilized this strategy to personalize therapy. Patients ≥60 years with a new diagnosis of AML underwent geriatric assessment prior to initiation of treatment. Geriatric assessment of physical function, cognitive function and comorbidity burden were used to determine fitness for chemotherapy. Patients with good or intermediate-risk AML received intensive chemotherapy such as anthracycline and cytarabine (7+3) if determined …

Acinetobacter Infections: A Retrospective Study To Determine In – Hospital Mortality Rate And Clinical Factors Associated With Mortality, Rajiv Patel

Theses & Dissertations

Background: Acinetobacter infections are increasingly being recognized as a cause for significant in – hospital morbidity and mortality worldwide. Increasingly multi – drug resistant strains of Acinetobacter are being isolated, increasing the burden on healthcare resources. Our objectives were to determine the outcomes and clinical factors related to outcomes of Acinetobacter infections at the Aga Khan University Hospital.

Methods: A retrospective study of Acinetobacter infections (from any site) was conducted. Patient records were used to gather relevant clinical information. The collected data was tabulated and analysed for any significant differences in demographic or clinical variables. The Pearson Chi squared test …

Modifiable Barriers To Optimal Outcomes In Gout Management, Brian W. Coburn

Theses & Dissertations

Improving patient outcomes in chronic disease is of critical importance to the future of health care. Gout, affecting 4% of the US population, is a highly treatable chronic disease from which patients experience unnecessarily suboptimal outcomes. In this dissertation, I demonstrate how interrelated patient and provider factors affect patient outcomes in gout. First, I describe how only 14% of gout patients know their serum urate (SU) goal for urate lowering therapy (ULT) despite otherwise being knowledgeable about gout and its treatment. I then demonstrate the importance of multiple patient and provider factors in achieving SU goal. Specifically, I demonstrate that …

Roles Of Serum Lycopene In The Prevalence And Mortality Of Metabolic Syndrome In The Adult Population, Guang-Ming Han

Theses & Dissertations

Metabolic syndrome (MetS) is a cluster of metabolic disorders, including increased fasting glucose, blood pressure, plasma triglyceride, reduced high-density lipoprotein cholesterol and abdominal obesity. It leads to an increased risk of cardiovascular disease and diabetes. The growing prevalence of MetS is strongly related to the increasing prevalence of overweight/obesity. As an antioxidant, lycopene can reduce the risk of MetS. However, it is unclear whether lycopene has similar effects among overweight/obese individuals and whether lycopene can reduce the risk of mortality among individuals with MetS. The purpose of this study was to explore the roles of lycopene in the prevalence and …

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 …