Medical Specialties Commons^™

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety In Aga Khan University Hospital; A Cohort Study, Anthony Kamau

Master of Medicine in Anaesthesiology

Background: Preoperative anxiety is a common perioperative complication, according to studies done it is seen in approximately 11-80% of adults undergoing surgery. Various pharmacological and non pharmacological techniques have been used to reduce preop anxiety. One of the goals of the preanaesthesia clinic is to allay anxiety. Literature shows that a preanaesthesia clinic evaluation reduces anxiety however b current studies done on anxiety and the preanaesthesia clinic have not quantified this reduction. Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward. Study Design: A cohort and before – after study …

Residual Disease And Hpv Persistence After Cryotherapy For Cervical Intraepithelial Neoplasia Grade 2/3 In Hiv Positive Women In Kenya, Hugo De Vuyst, Nelly R. Mugo, Silvia Franceschi, Kevin Mckenzie, Vanessa Tenet, Julia Njoroge, Farzana S. Rana, Samah R. Sakr, Peter J.F. Snijders, Michael Chung

Pathology, East Africa

Objective: To assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women.

Design: Follow-up study.

Methods: 79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells).

Results: At 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI):66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at …

Epidemiology Of Malaria In A Village In The Rufiji River Delta, Tanzania: Declining Transmission Over 25 Years Revealed By Different Parasitological Metrics, Anna Färnert, Victor Yman, Manijeh Vafa Homann, Grace Wandell, Leah Mhoja, Marita Johansson, Salome Jesaja, Johanna Sandlund, Kazuyuki Tanabe, Ulf Hammar, Matteo Bottai, Zul Premji, Anders Björkman, Ingegerd Rooth

Pathology, East Africa

Background: Assessments of the epidemiology of malaria over time are needed to understand changes in transmission and guide control and elimination strategies.

Methods: A longitudinal population study was established in 1985 in Nyamisati village in the Rufiji River Delta, Tanzania. A physician and research team lived in the village 1984–2000. Parasite prevalence by microscopy and two PCR methods, spleen rates and haemoglobin levels were measured in repeated cross-sectional surveys between 1985 and 2010. Passive surveillance of malaria cases was maintained until end 1999. Bed nets were distributed after the surveys 1993, 1999 and 2010.

Results: In 1985, overall parasite prevalence …

Uchunguzi (Journal Watch/Montre De Journal) April 2014, Benjamin Wachira

Family Medicine, East Africa

Content: If you want to know how we practised medicine 5 years ago, read a textbook. If you want to know how we practised medicine 2 years ago, read a journal. If you want to know how we practise medicine now, go to a (good) conference. If you want to know how we will practise medicine in the future, listen in the hallways and use FOAM (Joe Lex, 2012). FOAM is free, open-access medical education. As stated in the Hippocratic Oath: “…and to teach them this art – if they desire to learn it – without fee and covenant”, the …

Uchunguzi (Journal Watch/Montre De Journal) September 2014, Benjamin Wachira

Family Medicine, East Africa

No abstract provided.

Uchunguzi (Journal Watch/Montre De Journal) December 2014, Benjamin Wachira

Family Medicine, East Africa

No abstract provided.

Burden Of Epilepsy In Rural Kenya Measured In Disability-Adjusted Life Years, Fredrick Ibinda, Ryan Wagner, Melanie Bertram, Anthony Ngugi, Evasius Bauni, Theo Vos, Josemir Sander, Charles Newton

Family Medicine, East Africa

Objectives: The burden of epilepsy, in terms of both morbidity and mortality, is likely to vary depending on the etiology (primary [genetic/unknown] vs. secondary [structural/metabolic]) and with the use of antiepileptic drugs (AEDs). We estimated the disability-adjusted life years (DALYs) and modeled the remission rates of active convulsive epilepsy (ACE) using epidemiologic data collected over the last decade in rural Kilifi, Kenya.

Methods: We used measures of prevalence, incidence, and mortality to model the remission of epilepsy using disease-modeling software (DisMod II). DALYs were calculated as the sum of Years Lost to Disability (YLD) and Years of Life Lost (YLL) …

Exposure To Multiple Parasites Is Associated With The Prevalence Of Active Convulsive Epilepsy In Sub-Saharan Africa, Gathoni Kamuyu, Christian Bottomley, James Mageto, Brett Lowe, Patricia Wilkins, John C. Noh, Thomas B. Nutman, Anthony Ngugi, Rachael Odhiambo, Ryan Wagner, Angelina Kakooza-Mwesige, Seth Owusu-Agyei, Kenneth Ae-Ngibise, Honorati Masanja, Faith Osier, Peter Odermatt, Charles Newton

Family Medicine, East Africa

Background: Epilepsy is common in developing countries, and it is often associated with parasitic infections. We investigated the relationship between exposure to parasitic infections, particularly multiple infections and active convulsive epilepsy (ACE), in five sites across sub-Saharan Africa.

Methods and Findings: A case-control design that matched on age and location was used. Blood samples were collected from 986 prevalent cases and 1,313 age-matched community controls and tested for presence of antibodies to Onchocerca volvulus, Toxocara canis, Toxoplasma gondii, Plasmodium falciparum, Taenia solium and HIV. Exposure (seropositivity) to Onchocerca volvulus (OR = 1.98; 95%CI: 1.52-2.58, p

Conclusion: This study investigates how …

Acute Management Of St-Elevation Myocardial Infarction In A Tertiary Hospital In Kenya: Are We Complying With Practice Guidelines?, Benjamin Wachira, Andrew Owuor, Harun Otieno

Internal Medicine, East Africa

Introduction: Current practice guidelines emphasize the importance of rapid reperfusion of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the current rate of compliance with evidence-based practice guidelines for the management of STEMI patients at a tertiary hospital in Kenya.

Methods: This was a retrospective chart review. Data on patient characteristics, emergency treatment, and outcomes were collected on adults admitted with a diagnosis of STEMI from January 2012 to February 2013.

Results: Data were collected for 45 patient presentations. There were 37 male patients (82%). The mean age was 59.7 ± 3.8 years. Of …

Premature Mortality In Active Convulsive Epilepsy In Rural Kenya: Causes And Associated Factors, Anthony Ngugi, Christian Bottomley, Gregory Fegan, Eddie Chengo, Rachael Odhiambo, Evasius Bauni, Brian Neville, Immo Kleinschmidt, Josemir W. Sander, Charles R. Newton

Family Medicine, East Africa

Objective: We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya.

Methods: In this prospective population-based study, people with ACE were identified in a crosssectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors.

Results: There were 61 deaths among 754 people with ACE, yielding a rate of …

18fdg Synthesis And Supply: A Journey From Existing Centralized To Future Decentralized Models, Maseeh Uz Zaman, Nosheen Fatima, Zafar Sajjad, Unaiza Zaman, Rabia Tahseen, Areeba Zaman

Department of Radiology

Positron emission tomography (PET) as the functional component of current hybrid imaging (like PET/ CT or PET/MRI) seems to dominate the horizon of medical imaging in coming decades. 18Flourodeoxyglucose (18FDG) is the most commonly used probe in oncology and also in cardiology and neurology around the globe. However, the major capital cost and exorbitant running expenditure of low to medium energy cyclotrons (about 20 MeV) and radiochemistry units are the seminal reasons of low number of cyclotrons but mushroom growth pattern of PET scanners. This fact and longer half-life of 18F (110 minutes) have paved the path of a centralized …

Mdct Of Small Bowel Obstruction: How Reliable Are Oblique Reformatted Images In Localizing Point Of Transition?, Wasim Memon, Yasir Jamil Khattak, Tariq Alam, Luca Maria Sconfienza, Muhammad Awais, Shayan Sirat Maheen Anwar

Department of Radiology

The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemar's test was used to detect any statistical difference in POT …

Cancer Care Annual Report 2013-2014, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center.

The Role Of Scavenger Receptor Class B Type I-Regulated Inducible Glucocorticoids In Sepsis, Junting Ai

Theses and Dissertations--Nutritional Sciences

Sepsis claims over 215,000 lives in the US annually. Inducible glucocorticoids (iGC) is produced during sepsis. However, the precise effects of iGC in sepsis remain unclear due to a lack of appropriate animal models. Glucocorticoid (GC) insufficiency is associated with a marked increase in mortality and occurs in 60% of severe septic patients. Yet the conclusion of GC therapy on septic patients is still controversial.

Scavenger receptor class B type I (SR-BI) in the adrenal mediates the selective uptake of cholesteryl ester from lipoproteins for GC synthesis. SR-BI-/- mice completely lack iGC during sepsis and are highly susceptible to septic …

Differences In Mental Health Treatment Recommendations For Older And Younger Adults, Michelle M. Smith

Masters Theses

Failure to meet geriatric mental health needs is increasingly problematic. Research indicates that the problem is not simply a matter of insufficient numbers of mental health practitioners (MHPs), but also ageist attitudes and lack of knowledge about and training with older adults. The current study reviews the literature regarding knowledge about older people, education and training that mental health professionals receive, and the attitudes that are held by mental health professionals. The study also assessed for differences in treatment recommendations that MHP made for older versus younger clients, investigated whether MHP knowledge about the mental health of older adults, attitudes …

Completely Intracorporeal Robotic-Assisted Laparoscopic Ileovesicostomy, Maryellen T. Dolat, Greg Wade, B. Mayer Grob, Lance J. Hampton, Adam P. Klausner

Surgery Publications

We present a report of a completely intracorporeal robotic-assisted laparoscopic ileovesicostomy with long term follow-up. The patient was a 55-year-old man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction. The procedure was performed using a da Vinci Surgical system (Intuitive Surgical, Sunnyvale, CA) and took 330 minutes with an estimated blood loss of 100 mL. The patient recovered without perioperative complications. He continues to have low pressure drainage without urethral incontinence over two years postoperatively.

Donor Heart Utilization Following Cardiopulmonary Arrest And Resuscitation: Influence Of Donor Characteristics And Wait Times In Transplant Regions, Mohammed Quader, Luke Wolfe, Gundars Katlaps, Vigneshwar Kasirajan

Surgery Publications

Background. Procurement of hearts from cardiopulmonary arrest and resuscitated (CPR) donors for transplantation is suboptimal. We studied the influences of donor factors and regional wait times on CPR donor heart utilization. Methods. From UNOS database (1998 to 2012), we identified 44,744 heart donors, of which 4,964 (11%) received CPR. Based on procurement of heart for transplantation, CPR donors were divided into hearts procured (HP) and hearts not procured (HNP) groups. Logistic regression analysis was used to identify predictors of heart procurement. Results. Of the 4,964 CPR donors, 1,427 (28.8%) were in the HP group. Donor characteristics that favored heart procurement …

Is The Consistency More Important Than The Ingredients For Treatment? Case Report For Eosinophilic Esophagitis, Dan W. Parrish, Shashank Sharma, Santhosh Kumar

Surgery Publications

Eosinophilic Esophagitis seems to be an ever-changing disease, from patient-to-patient and from year-to-year in the same patient. Improvements in these patients’ lives have been made with the realization that elimination of dietary antigens helped with symptom relief and treatment with topical steroids assisted in eradication of esophageal eosinophils.

This case study has two very important aspects that should be emphasized. The first is the realization that it may be consistency of the steroid mixture rather than the ingredients that infer the effectiveness of the EoE treatment, and the second aspect is the willingness of the medical team to listen to …

Catalog (2014-2015), Philadelphia College Of Osteopathic Medicine

Catalogs

A snapshot of the PCOM curriculum through the decades.

Firesetting And Maltreatment, Amy L. Burnett, Hatim A. Omar

Pediatrics Faculty Publications

In this chapter we try to determine if a link exists between firesetting offenders and a past history of maltreatment. A literature review was performed using research from various studies and populations. Firesetting is a significant problem that affects the world's youth today. Even though there is substantial loss of property and life from juvenile firesetters, there is not a great deal of research to provide insight into early identification of those at risk. In the literature review performed, 6 of 7 studies found a link with maltreatment and firesetting behaviors. There does seem to be a correlation between the …

Children, Violence And Bullying, Joav Merrick, Isack Kandel, Hatim A. Omar

Pediatrics Faculty Publications

Adolescent violence is a very visible phenomenon in our modern society, where you just have to open the newspaper or the television and you find yourself right in the middle of it. In order to understand the scope of the problem, we need to look at the epidemiology of global violence. Each year, more than 1.6 million people worldwide lose their lives to violence and for every person who dies as a result of violence, many more are injured and suffer from a range of physical, sexual, reproductive and mental health problems. Violence places a massive burden on national economies …

Adolescent Violence Prevention, Hatim A. Omar

Pediatrics Faculty Publications

Violence in adolescence has seen an increase since the 1990s with dramatic statistics on violent death and risk behaviors. School violence has been focused upon by a huge media coverage of especially violent cases that could have had some endemic consequences worldwide. We present a case of a 14 year old white male with change in school behavior, strategies for the case investigation, its results and long term prevention. Other research has shown that preventive measures during pregnancy, infancy and childhood can prevent adolescent and adult delinquency.

Prevention: Sexual Violence Against Adolescent And Young Adult Women, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

No abstract provided.

A Grassroots Program For Youth Suicide Prevention, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Suicide is a major public health problem. It affects people of all ages. Youth, in particular, have a disturbingly high suicide rate. Suicide is the third leading cause of death for young people between the ages of 10 and 24 (1). Approximately 4600 young people die each year from a suicide attempt (1). The most common methods used in suicides are firearms (45%), suffocation (which may be in the form of hanging) (40%), and poisoning (8%) (1). However, more young people survive suicide attempts than actually die from the attempt. A national survey of youth in both private and public …

Assessment Of Apparent Diffusion Coefficient Values As Predictor Of Aggressiveness In Peripheral Zone Prostate Cancer: Comparison With Gleason Score, Shayan Sirat Maheen Anwar, Zahid Anwar Khan, Rana Shoaib Hamid, Fahd Haroon, Raza Sayani, Madiha Beg, Yasir Jamil Khattak

Department of Radiology

Purpose. To determine association between apparent diffusion coefficient value on diffusion-weighted imaging and Gleason score in patients with prostate cancer. Methods. This retrospective case series was conducted at Radiology Department of Aga Khan University between June 2009 and June 2011. 28 patients with biopsy-proven prostate cancer were included who underwent ultrasound guided sextant prostate biopsy and MRI. MRI images were analyzed on diagnostic console and regions of interest were drawn. Data were entered and analyzed on SPSS 20.0. ADC values were compared with Gleason score using one-way ANOVA test. Results. In 28 patients, 168 quadrants were biopsied and 106 quadrants …

Immediate Return To Ambulation And Improved Functional Capacity For Rehabilition In Complex Regional Pain Syndrome Following Early Implantation Of A Spinal Cord Stimulation System, Brandon Jesse Goff, Jeremy Wingseng Naber, John Patrick Mccallin, Edward Michael Lopez, Kevin Brant Guthmiller, Karl Alan Lautenschlager, Tristan Toll Lai, Dean Harry Hommer, Gonzalez Raul Marin

PCOM Scholarly Works

Complex regional pain syndrome (CRPS) is a neuropathic pain condition that is characterized by vasomotor, sensory, sudomotor, and motor symptoms. Spinal cord stimulation (SCS) has been successfully utilized for the treatment of pain refractory to conventional therapies. We present a case of a previously highly functioning 54-year-old female who developed a rarely reported case of idiopathic CRPS of the right ankle which spontaneously occurred four months after an uncomplicated anterior cervical disc fusion. This condition resulted in severe pain and functional impairment that was unresponsive to pharmacological management. The patient's rehabilitation was severely stymied by her excruciating pain. However, with …

Standardized Training Examinations Among Ophthalmology Residents And The American Board Of Ophthalmology Written Qualifying Examination First Attempt: The Morsani College Of Medicine Experience, Andrew Carey, Mitchell Drucker

Ophthalmology Faculty Publications

Purpose: The aim of the study is to demonstrate whether resident performance on the United States Medical Licensing Exam (USMLE) Step 1 and the Ophthalmology Knowledge Assessment Program (OKAP) correlates to American Board of Ophthalmology Written Qualifying Examination (ABO-WQE).

Design: This is a retrospective cohort study.

Participants: Forty-one residents who completed their postgraduate training between 1999 and 2011 from our institution were included in the study.

Methods: Percentiles on the USMLE Step 1, OKAP, and ABO-WQE first attempt were recorded and analyzed for possible correlations among scores across examinations using Pearson rank correlation, chi-square analysis, Fisher exact test, and Student …

A Randomized Control Trial Comparing Weight Adjusted Dose Versus Fixed Dose Prophylactic Phenylephrine Infusion On Maintaining Systolic Blood Pressure During Caeserean Section Under Spinal Anaesthesia, Lucy Wambui Mwaura

Master of Medicine in Anaesthesiology

Background: Spinal anaesthesia is the standard of care for elective caesarean delivery. Its advantages over general anaesthesia include: decreased blood loss, reduced postoperative pain and faster recovery time. Despite these advantages, the sympathetic blockade induced by spinal anaesthesia results in 80 percent incidence of hypotension without prophylactic management. This hypotension can cause: nausea, vomiting, cardiovascular collapse or even loss of consciousness in the mother, and fetal acidosis. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in …

Incidence And Risk Factors For Acute Myocardial Injury After Non-Cardiac Surgery At The Aga Khan University Hospital Nairobi, Salim Said Ahmed

Master of Medicine in Internal Medicine

Aim: To determine the incidence and risk factors for acute myocardial injury after non-cardiac surgery at Aga Khan University Hospital Nairobi. Design: Prospective cohort study Background: Myocardial injury is the most common major cardiovascular complication in patients undergoing non-cardiac surgery. Large numbers of intermediate-risk and high-risk cardiac patients will be undergoing surgery as the population grows older, and thus myocardial injury after non-cardiac surgery could be a rising problem. Patients and Setting: Adult participants undergoing intermediate and high risk non-cardiac surgery at the Aga Khan University Hospital Nairobi were evaluated for incidence and risk factors for myocardial injury after non-cardiac …

Comparison Of Cardiometabolic Risk Profile Between Hiv Patients On Art And Those Who Are Art Naïve, Erick Kimani Njenga

Master of Medicine in Internal Medicine

Background: Metabolic syndrome comprises of a set of aggregated risk factors that include: hypertension, central obesity, impaired fasting glucose, hypertriglyceridemia and low HDL-C (1)The is a noted increase in the prevalence of the metabolic syndrome cardiovascular risk factors in the HIV population. Methods: The study is a cross-sectional survey that enrolled 157 HIV positive patients over a 4 month period that were either newly diagnosed (HIV ART naïve) or were on ART from both the inpatient and outpatient setting. Data of their anthropometric, cardiovascular risk factors and clinical characteristics were collected with the aid of a standardized questionnaire and serum …