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Articles 31 - 56 of 56
Full-Text Articles in Internal Medicine
Eligibility And Patient Barriers To Peritoneal Dialysis In Patients With Advanced Chronic Kidney Disease, Saleem Mohamed Abdulkarim
Eligibility And Patient Barriers To Peritoneal Dialysis In Patients With Advanced Chronic Kidney Disease, Saleem Mohamed Abdulkarim
Master of Medicine in Internal Medicine
Introduction: The burden of chronic kidney disease is on the rise in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require renal replacement therapy in the form of hemodialysis or peritoneal dialysis. The predominant modality utilized in Kenya is currently hemodialysis despite peritoneal dialysis having similar survival outcomes with the potential benefit of cost-effectiveness. There is need therefore to explore why peritoneal dialysis remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of peritoneal dialysis. Purpose: The main objective of this study is to …
Disease Activity And Functional Status And Their Relation To Depression In Patients With Rheumatoid Arthritis, Joe Rosana Rakiro
Disease Activity And Functional Status And Their Relation To Depression In Patients With Rheumatoid Arthritis, Joe Rosana Rakiro
Master of Medicine in Internal Medicine
Introduction: Rheumatoid Arthritis, one of the commonest forms of inflammatory arthritis, has significant societal impact with regards to cost, induction of disability and loss of productivity. This impact is magnified in the presence of comorbid mood disorders, as these constitute independent factors for unexplained flares and relapses. Purpose: The primary purpose of this study was to determine the correlation between disease activity and depression in Rheumatoid Arthritis patients. Methods: Patients with Rheumatoid Arthritis attending rheumatology clinic at Aga Khan University Hospital, Nairobi were recruited into the study. The patients’ disease activity and functional status were assessed using the Clinical Disease …
Barriers To Definitive Hyper-Acute Management Of Stroke At A Tertiary Facility In Nairobi, Kenya, Caroline Wangui Mithi
Barriers To Definitive Hyper-Acute Management Of Stroke At A Tertiary Facility In Nairobi, Kenya, Caroline Wangui Mithi
Master of Medicine in Internal Medicine
Background: Stroke is a sudden neurological deficit due to a vascular cause, which can be ischaemic, haemorrhagic stroke or another cause. It is a leading cause of disability and long term functional impairment in the world. The definitive management of an acute ischaemic stroke is thrombolysis and/or mechanical thrombectomy, both of which has been shown to improve functional outcome but the utilization remains quite low in most hospitals, especially in Africa. This is due to certain pre-hospital and in-hospital barriers, and these factors have been shown to differ from country to country. Objective: To determine the pre-hospital barriers that prevent …
Acinetobacter Infections: A Retrospective Study To Determine In – Hospital Mortality Rate And Clinical Factors Associated With Mortality, Rajiv Patel
Master of Medicine in Internal Medicine
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 …
Long-Term Outcomes And Factors Associated With Mortality Among Patients With Moderate To Severe Pulmonary Hypertension In Kenya, Abdulaziz Mansur Abeid
Long-Term Outcomes And Factors Associated With Mortality Among Patients With Moderate To Severe Pulmonary Hypertension In Kenya, Abdulaziz Mansur Abeid
Master of Medicine in Internal Medicine
Background: Pulmonary hypertension (PH) is a condition that carries significant morbidity and mortality. Studies done in sub-Saharan Africa have reported poor short-term outcomes. However, data on long-term outcomes and prognostic factors are lacking. Objectives: This study sought to determine the one and two-year survival rates and prognostic factors associated with mortality in patients with moderate to severe PH. Methods: A retrospective review of moderate to severe PH patients [pulmonary artery systolic pressure (PASP), ≥45 mmHg] diagnosed at Aga Khan University Hospital, Nairobi from 2014 to 2017 was carried out. Demographic, clinical and in hospital outcome data were extracted from medical …
A Randomized Control Trial Of English-Speaking Advanced Cancer Patients At Akus Medical And Surgical Clinics And The Impact On Qol Of One Session Of Dignity Therapy, Miriam Gatehi-Muriithi
A Randomized Control Trial Of English-Speaking Advanced Cancer Patients At Akus Medical And Surgical Clinics And The Impact On Qol Of One Session Of Dignity Therapy, Miriam Gatehi-Muriithi
Master of Medicine in Internal Medicine
Background: Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005. Methods: This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. Data collected was presented as Legacy documents to group 1 participants. Post intervention ESAS scores were obtained in both groups after 6 weeks. …
Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At Akuhn, Stephen Omondi Otieno
Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At Akuhn, Stephen Omondi Otieno
Master of Medicine in Internal Medicine
Background: An advance directive is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves, and which is then used to guide decisions on life-sustaining treatment in the event that they become incapacitated. Advance directives can take one of four forms: a living will, a limitation of care document, a do-not-resuscitate order, and an appointment of a surrogate by durable power of attorney. The completion rate of advance directives varies from region to region, and it is influenced by different patient, caregiver, legal, institutional, cultural, and religious factors. …
Outcomes In Patients With Acute Coronary Syndromes At The Aga Khan University Hospital, Nairobi, Mohamed Hasham Varwani
Outcomes In Patients With Acute Coronary Syndromes At The Aga Khan University Hospital, Nairobi, Mohamed Hasham Varwani
Master of Medicine in Internal Medicine
Background: As the prevalence of cardiovascular diseases in Sub-Saharan Africa rises, coronary artery disease, with its acute presentations, is being increasingly recognized in Kenyans and treated at tertiary level hospitals. It is just over a decade since the introduction and wide availability of modern cardiology services, including interventional cardiology in Kenya. Following an acute coronary syndrome (ACS), patients remain at high risk of death and other adverse events such as heart failure, recurrent myocardial infarction, stroke, and bleeding. Local and regional data on long-term outcomes following ACS are lacking. These data are important to clinicians for prognostication and to health …
The Association Between Asymptomatic And Mild Neurocognitive Impairment And Adherence To Antiretroviral Therapy Amongst People Living With Hiv, Violet Maloba Awori
The Association Between Asymptomatic And Mild Neurocognitive Impairment And Adherence To Antiretroviral Therapy Amongst People Living With Hiv, Violet Maloba Awori
Master of Medicine in Internal Medicine
Background: HIV disease is associated with neurocognitive impairment which is one of the neurological complications of the viral infection. The spectrum of HIV Associated neurocognitive impairment has significantly changed since the advent of ART. The inclusion of the asymptomatic but cognitively impaired population of patients has changed the dynamics of this population, and requires further research to identify the impact it has on the progression of the disease as well as on any other aspects. Poor adherence to ART is one of the main causes of treatment failure and studies done previously point towards the milder forms of Neurocognitive Impairment …
Risk Factors, Clinico-Pathologic Characteristics And Outcomes In Young Kenyan Female Patients With Breast Cancer In Akuh-N, Gilford Mutwiri Mwikamba
Risk Factors, Clinico-Pathologic Characteristics And Outcomes In Young Kenyan Female Patients With Breast Cancer In Akuh-N, Gilford Mutwiri Mwikamba
Master of Medicine in Internal Medicine
Background: Breast cancer in the young refers to a diagnosis of breast cancer in a female under the age of forty years. This is considered a distinct disease with different risk factors, biology, and prognosis. Young age at breast cancer diagnosis is reportedly more common among African-Americans. The highest proportion of breast cancer in the young has been reported in Africa. Early detection of breast cancer in Africa is hampered by lack of access to health care services, appropriate screening tools, and high cost of magnetic resonance imaging for the high risk groups. Despite a worse prognosis, management of breast …
The Diagnostic Accuracy Of Determine™ Tb Lam Antigen In Detection Of Extra Pulmonary Tuberculosis (Eptb), Fatimah Osman Juma
The Diagnostic Accuracy Of Determine™ Tb Lam Antigen In Detection Of Extra Pulmonary Tuberculosis (Eptb), Fatimah Osman Juma
Master of Medicine in Internal Medicine
Background: TB remains a key global health challenge; particularly Extra pulmonary Tuberculosis (EPTB) and is also a major cause of morbidity and mortality in sub-Saharan Africa. The increasing incidence of EPTB compounded by difficulties in making a timely diagnosis portends to poor prognosis and increased mortality. Delays in diagnosis and misdiagnosis of EPTB in suspected patients account for mortality as well. Challenges in diagnosis of EPTB are mainly due to disease related factors, the paucibacillary nature of disease and challenges with sample collection and processing. Reference standard test such as TB culture, geneXpert and histology which are used in the …
Respiratory Function Amongst Asymptomatic Hiv Positive And Hiv Negative Clients At Aga Khan University Hospital, Nairobi, Noah Kipkemei Murbiy
Respiratory Function Amongst Asymptomatic Hiv Positive And Hiv Negative Clients At Aga Khan University Hospital, Nairobi, Noah Kipkemei Murbiy
Master of Medicine in Internal Medicine
Background: Spirometry is used to asses respiratory function abnormalities. This is usually in reference to a validated normal range unique to a particular gender, race, age, weight and height. Majority of persons are usually asymptomatic until the expected FEV1 has decreased by 50%. Early intervention on the abnormalities even in this asymptomatic group has been shown to retard the rate of pulmonary deterioration. An unpublished audit at the Aga Khan University Hospital, Nairobi, revealed that majority of newly diagnosed HIV positive persons were admitted at the Critical Care Units with a pulmonary cause which later resulted in poor outcomes. This …
Comparison Of Cardiovascular Risk Profiles Amongst Newly Diagnosed Cancer Patients And Non-Cancer Patients At The Aga Khan University Hospital Nairobi, Majid Lingani-Ncube Sikosana
Comparison Of Cardiovascular Risk Profiles Amongst Newly Diagnosed Cancer Patients And Non-Cancer Patients At The Aga Khan University Hospital Nairobi, Majid Lingani-Ncube Sikosana
Master of Medicine in Internal Medicine
Background: Non-Communicable Diseases (NCDs) are fast becoming the leading causes of morbidity and mortality in Low and Middle-income countries (LMIC) with cancers and cardiovascular diseases (CVDs) becoming the most prominent. CVD can be prevented if appropriate measures of screening and treatment of modifiable risk factors are addressed. This may translate to reduced risk of CVDs and some cancers in the long term. Increasing evidence exhibits common risk factors for both CVDs and cancer and that CVDs and their risk factors when present in cancer patients may worsen the overall outcome. Objectives: The primary objective was to determine and compare the …
Incidence And Risk Factors For Acute Myocardial Injury After Non-Cardiac Surgery At The Aga Khan University Hospital Nairobi, Salim Said Ahmed
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
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 …
Prevalence And Clinical Characteristics Of Venous Thromboembolism At The Aga Khan University Hospital, Nairobi, Felix Mutuma Riunga
Prevalence And Clinical Characteristics Of Venous Thromboembolism At The Aga Khan University Hospital, Nairobi, Felix Mutuma Riunga
Master of Medicine in Internal Medicine
Aim: To determine the prevalence of venous thromboembolism in patients presenting to the Aga Khan University Hospital, Radiology Department for lower limb compression ultrasonography with doppler and CT pulmonary angiography. In those found to have venous thromboembolism, the distribution of risk factors as described by Wells, the pattern of clinical presentation, the pattern of initial therapy, the length of hospital stay, major bleeding episodes and in hospital mortality were described. Design: Prospective survey Background: Venous Thromboembolism is a major cause of morbidity and mortality worldwide and its occurrence locally, as well as its clinical characteristics needs to be described in …
Effect Of Mobile Phone Short Message Service On Adherence Rates To Antihypertensives At The Family Medicine Clinic, Barbara Karau
Effect Of Mobile Phone Short Message Service On Adherence Rates To Antihypertensives At The Family Medicine Clinic, Barbara Karau
Master of Medicine in Internal Medicine
Background: Systemic arterial hypertension is the main modifiable risk factor for development of cardiovascular disease, which is the number one cause of death in high income countries and is increasingly becoming a cause of concern in Sub-Saharan Africa (1). Awareness, management and overall control of hypertension in Sub-Saharan Africa is poor (2,3). Poor control stems from various causes; one being patient non-adherence with medication, a factor amenable to modification. The use of mobile health for behavioural change from low resource settings is gaining widespread use in management of communicable diseases (4,6). Mobile phone has the potential to significantly influence patients …
Prevalence And Factors Associated With Depression Among Patients With Epilepsy In A Kenyan Tertiary Care Hospital, Nduku Kiko
Master of Medicine in Internal Medicine
Aim: To determine the prevalence and factors associated with depression in patients with epilepsy at Aga Khan University Hospital Nairobi. Design: Cross-sectional Survey Background: Depression is a recognized common co-morbidity of epilepsy that often goes untreated and has great impact on quality of life of patients and management of patients with epilepsy. Patients and Setting: Patients with epilepsy on follow up at the Aga Khan University Hospital were evaluated for presence and factors associated with depression. Methodology: The study recruited eligible patients with epilepsy who were on follow up in the neurology clinic. Beck Depression Inventory was administered to evaluate …
Hepatitis B Vaccination Rate And Determining Factors Amongst Health Care Workers At Aga Khan University Hospital, Nairobi, Herman Ekea
Master of Medicine in Internal Medicine
Aim: To determine Hepatitis B vaccination rate and determining factors for health care workers (HCWs) at AKUHN. Design: Cross sectional analytical study Study subjects and setting: Aga Khan University Hospital-Nairobi, is a 254 bed tertiary hospital, with 815 HCWs with occupational risk of infection with hepatitis B virus (HBV). The hospital has a HCW vaccination policy and vaccine available to HCWs as part of medical scheme Methodology: Two hundred and sixty six (266) eligible HCWs of all cadres were stratified then randomly recruited after giving informed consent. A questionnaire was then administered to assess knowledge, attitude and practice towards HBV …
The Influence Of Depression On Adherence To Antiretroviral Therapy Among Hiv Infected Patients At Aga Khan University Hospital (Nairobi), Evelyn W. Karanja-Mbugua
The Influence Of Depression On Adherence To Antiretroviral Therapy Among Hiv Infected Patients At Aga Khan University Hospital (Nairobi), Evelyn W. Karanja-Mbugua
Master of Medicine in Internal Medicine
Aim: To determine the influence of depression on adherence to antiretroviral (ARV) therapy among HIV-infected patients. Design: Cross-sectional survey Patients: One hundred and forty HIV-positive patients on treatment with Combination Antiretroviral Therapy selected from the out-patient department of Aga Khan University Hospital took part in the survey. Methodology: Every third patient who was eligible was assessed for adherence to antiretroviral therapy using The Adult AIDS Clinical Trial Group follow up adherence questionnaire followed by screening for depression using the Patient Health Questionnaire 9. Pharmacy data was then retrieved for the same patients and used to assess adherence by the medication …
An Analysis Of The Clinical Practice Of Emergency Medicine In Public Emergency Centres In Kenya, Benjamin W. Wachira
An Analysis Of The Clinical Practice Of Emergency Medicine In Public Emergency Centres In Kenya, Benjamin W. Wachira
Master of Medicine in Internal Medicine
Objectives: To describe the case mix, interventions, procedures and management of patients in public accident and emergency departments (A&Es) in Kenya. Methods: This was an observational study of patients who presented to 15 A&Es from 1 October to 31 December 2010. The study was conducted across Kenya in two national referral hospitals, five secondary level hospitals, and eight primary level hospitals. All patients presenting alive to the A&E during the 24 hour study period that were seen by a doctor or clinical officer were included in the study. A data collection form was completed by the primary investigator at the …
Peripheral Arterial Disease In Hiv Positive And Negative Subjects At The Aga Khan University Hospital, Nairobi, Farida Kaittany
Peripheral Arterial Disease In Hiv Positive And Negative Subjects At The Aga Khan University Hospital, Nairobi, Farida Kaittany
Master of Medicine in Internal Medicine
Aim: To determine the prevalence of peripheral arterial disease (PAD) amongst HIV positive patients and HIV negative subjects and associated risk factors at Aga Khan Hospital Nairobi Design: Cross-sectional descriptive study Patients and Setting: A group of 125 HIV positive and 120 HIV negative subjects aged between 40 – 70 years were included in the study. HIV negative subjects were sampled from HIV positive patients attending the HIV outpatient clinic while HIV negative subjects were sampled from blood donor unit at theAga KhanUniversityHospital. Methodology: Two separate convenient samples were selected for the study. The first sample was a group of …
A Randomised Comparative Trial Of Seven Versus Fourteen Day Triple Therapy For Helicobacter Pylori Eradication At The Aga Khan University Hospital, Nairobi, Ahmed Sokwala
Master of Medicine in Internal Medicine
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 …
Risk Of Contrast Induced Nephropathy In Hiv Patients Receiving Radiographic Contrast At Three Aga Khan Hospitals, Sitna A. Mwanzi
Risk Of Contrast Induced Nephropathy In Hiv Patients Receiving Radiographic Contrast At Three Aga Khan Hospitals, Sitna A. Mwanzi
Master of Medicine in Internal Medicine
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 which …
A Randomised Comparative Clinical Trial Of Prokinetic Agents And Proton Pump Inhibitors In H. Pylori Negative Non-Ulcer Dyspepsia, Mzee Ngunga
Master of Medicine in Internal Medicine
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. …
Prevalence, Risk Factors And Outcome Of Acute Kidney Injury At The Aga Khan University Hospital Nairobi, Peter W. Munyu
Prevalence, Risk Factors And Outcome Of Acute Kidney Injury At The Aga Khan University Hospital Nairobi, Peter W. Munyu
Master of Medicine in Internal Medicine
Introduction: Acute kidney failure (acute kidney injury, AKI) is a group of syndromes that result in a decline in the glomerular filtration rate. In 2002, the Acute Dialysis Quality Initiative (ADQI) group proposed the RIFLE criteria to standardize the definitions of AKI severity and outcome. This criterion has been validated in several studies. AKI is frequently encountered in hospitalized patients; it has a negative impact on mortality and morbidity. A lot of work has been done to describe the epidemiology of AKI in developed countries. The same does not apply for developing countries. This study was designed to evaluate AKI …