Pathology Commons^™

The Evaluation Of Anti-Factor Xa Levels In Hospitalised Patients Receiving Low Molecular Weight Heparin (Lmwh): A Prospective Study, Tandzile Thandwayinkosi Simelane

Master of Medicine in Clinical Pathology

Background 

Patients admitted to the hospital have been reported to have coagulation abnormalities due to various factors including immobilisation, preexisting disease, and current illness. The overall incidence of venous thromboembolism (VTE) in critically ill patients varies from 15% to well over 50%, even with the use of prophylactic measures in most patients. Low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are the recommended drugs for VTE prophylaxis in inpatient care. Although not standardly recommended, the laboratory can offer monitoring of anti-Factor Xa using the gold standard method of chromogenic anti-Factor X assay. The anti-Factor Xa levels are notably affected …

Comparison Between Acute Leukaemia Screening Tube And Lineage Specific Panels For The Diagnosis Of Acute Leukaemia At The Aga Khan University Hospital, Nairobi, Douglas Irimu Munga

Master of Medicine in Clinical Pathology

Introduction; Acute leukaemia is a heterogeneous group of haematological malignancies. It is categorized depending on the immature cells that proliferate and replace the normal tissue in the bone marrow. The broad categories are acute myeloid leukaemia if the immature cells are myeloblasts and acute lymphoid leukaemia if lymphoblasts. Other rare categories are blastic plasmacytoid dendritic cell neoplasm (BPDCN) and acute leukaemias of ambiguous lineage which include acute undifferentiated leukaemia and mixed phenotype acute leukaemias (MPALs). The classification is important as the treatment and management differ hence a timely and accurate diagnosis is paramount. Multiparameter comparison of the immunophenotype is possible …

Diagnostic Accuracy Of High-Sensitivity Cardiac Troponin In The Diagnosis Of Acute Myocardial Infarction At The Aga Khan University Hospital Nairobi, Kenya, Assumpta Wanjiru Chege

Master of Medicine in Clinical Pathology

Methodology: This cross-sectional study was carried out at Aga Khan University Hospital, Nairobi between July 1st 2020 and December 31st 2021. Participants were adults aged 18 years and above presenting to the emergency department with signs and symptoms suggesting an acute myocardial infarction. Patients were identified on the hospital management information system (CARE 2000) using test results for baseline high-sensitivity cardiac troponin I. The final diagnosis as well as secondary clinical data was obtained from both physical and electronic patient medical records. The reference standard for the diagnosis of acute myocardial infarction was taken as the final clinical diagnosis made …

Comparison Of Two Immunoassays For Detection Of Anti-Sars Cov-2 Antibodies Among Healthcare Workers At A Tertiary Referral Hospital In Nairobi, Kenya, Patrick Muriuki Mugaine

Master of Medicine in Clinical Pathology

Background: Tests for antibodies against severe acute respiratory syndrome coronavirus 2, the aetiologic agent of coronavirus disease 2019, provide evidence of past infection or immunization. At the individual level, they are useful as markers of protection against severe disease and in cases where the diagnosis by nucleic acid amplification is inconclusive. At the population level, they are an indirect measure of exposure and may be useful in monitoring changes in viral infection or uptake of immunization over time. The interpretation and optimal use of antibody assays on populations requires an appreciation of the wide variability in individual antibody responses, the …

Comparison Of Maldi-Tof Ms And 16s Rrna Sequencing For Identification Of A Collection Of Clinical Isolates Of Nonntuberculous Mycobacteria In Kenya And Describing Their Antimicrobial Susceptibilities, David Enoch Kawalya

Master of Medicine in Clinical Pathology

Study background: non-tuberculous mycobacteria (NTM) are members of the genus Mycobacteria that are ubiquitous in the environment. They are increasingly documented to cause multi-drug resistant human and animal infections in immunocompromised as well as immunocompetent hosts and thus, they are a huge burden on public health resources. Diagnosis and treatment of these infections is particularly challenging due to their variable clinical presentation and the lack of easily accessible identification methods. MALDI-TOF MS is a proteomic method that has gained traction in the identification of microbial organisms in clinical practice due to its fast turn-around time, high resolution, and cost-effectiveness but …

The Utility Of An Initial Point-Of-Care Lactate In Predicting In-Hospital Mortality Among Adult Patients With Sepsis And Septic Shock At The Emergency Department Of A Tertiary Hospital In Nairobi, Gicheru B. Nyachira

Master of Medicine in Clinical Pathology

Background: Sepsis is a leading cause of death and now a global health priority. Rapid identification, diagnosis and intervention can result in reduced in-hospital mortality. Elevated lactate has been shown to be a strong predictor of in-hospital mortality. However, the optimal cut-off has not been well defined. Identification of the optimal Point-of-Care (POC) lactate cut off that best predicts in-hospital mortality can therefore be used to rapidly risk stratify patients with suspected sepsis and septic shock presenting to the emergency department allowing for immediate intervention. Objective: To determine the lactate cutoff from an initial Point-of-Care lactate result from a GEM …

Immunophenotypic Expression Profile Of Multiple Myeloma Cases At A Tertiary Hospital In Nairobi, Kenya, Isabella Chelagat Mengich

Master of Medicine in Clinical Pathology

Background; Multiple myeloma (MM) is a heterogeneous disease with variable patient outcomes ranging from indolent to aggressive disease. GLOBOCAN data places Kenya amongst the top five African countries for MM incidence and MM-related mortality. Aberrant expression of CD56, CD117, Cyclin D1 and Ki-67 on neoplastic plasma cells has been demonstrated to be useful in disease prognostication. However, majority of the data on MM comes from western countries. The significance of expression of this markers is uncertain in our population. The aim of this study was to determine the immunophenotypic expression profile of CD56, CD117, Cyclin D1 and Ki-67 in a …

Comparison Of Staphylococcus Aureus Nasal Carriage By Patients And Healthcare Workers In Selected Dialysis Centers In Nairobi And Neighbouring Counties, Enock Serem

Master of Medicine in Clinical Pathology

Background: Staphylococcus aureus (S. aureus) is a significant pathogen that causes both community and hospital acquired infections. The burden of S. aureus morbidity and mortality is disproportionately high in patients with end stage kidney disease undergoing dialysis. With the rising prevalence of non-communicable diseases leading to end stage renal disease and dialysis, the impact of S. aureus infections is projected to rise. Knowledge of nasal carriage of S. aureus and their antibiotic resistance profiles is essential in improving patient care through planning of infection prevention and control strategies as well as formulating appropriate empiric antibiotic guidelines. The aim of this …

Von Willebrand Disease Among Women Of African Descent Attending The Aga Khan University Hospital Nairobi, With Menorrhagia, Angela Nabutilu Munoko

Master of Medicine in Clinical Pathology

Introduction: Von Willebrand Disease (VWD) is the most common heritable bleeding disorder with equal prevalence reported across the races. Women are more likely to present with excessive bleeding due to menstruation and child bearing. Studies have found that 5-24% of women presenting with menorrhagia have VWD. Women of African descent are under-represented in studies carried out on Von Willebrand disease and lower prevalence has been reported in this population. VWD has variable penetrance and racial differences in genetic mutations may influence presentation and disease severity. It was predicted that the standardization of the study conditions (case definition of menorrhagia, use …

The Predictive Value Of Urine Dipstick Glucose Test In The Screening For Gestational Diabetes Mellitus In A Tertiary Private Hospital In Kenya, Janet Maranga

Master of Medicine in Clinical Pathology

Background: Worldwide, there is no consensus on the best approach to diagnose gestational diabetes mellitus (GDM) and though oral glucose tolerance testing (OGTT) is considered the gold standard, practices in the administration and interpretation of the test differ depending on the guidelines in use. Previous studies have questioned the utility of glycosuria as a screening test for GDM. Since the studies were conducted, there have been diagnostic threshold changes that might impact its utility. Justification: Diagnostic cut-offs of OGTT used in GDM diagnosis have evolved over time necessitating re-evaluation of glycosuria. The study was aimed at re-assessing the utility of …

Reference Intervals For Prothrombin Time And Activated Partial Thromboplastin Time Derived From Black African Blood Donors At A University Teaching Hospital In Nairobi, Kenya, Abubakar Abdillah

Master of Medicine in Clinical Pathology

Introduction: Prothrombin time (PT) and activated partial thromboplastin time (APTT) are important coagulation screening tests that give an insight into how well the extrinsic and intrinsic arms of the coagulation cascade are performing. For correct interpretation of laboratory results and avoidance of errors and misdiagnosis, population specific RIs are most appropriate. In a healthcare setting, it is up to the laboratory to establish RIs for use for the particular analytes that they run, or at least verify the RIs availed by the manufacturer of the reagents for a particular analyte. Objectives: This study aimed to establish reference intervals (RIs) for …

Diagnostic Accuracy Of Hba1c Test In Diagnosis Of Diabetes And Prediabetes In A Multiethnic Population At Aga Khan University Hospital, Nairobi., Francis Kiigu Wathigo

Master of Medicine in Clinical Pathology

Introduction: Diabetes mellitus is a metabolic disease characterized by hyperglycaemia secondary to impaired insulin secretion, impaired insulin action or both. In Kenya, an estimated 750,000 people are diabetic with more than 50% estimated to be unaware of their status. Conventionally, diagnosis has been based on plasma glucose levels. In 2010, Haemoglobin A1c (HbA1c) was approved by the American Diabetes Association (ADA) and World Health Organisation (WHO) for diagnosis of diabetes. However, different studies have shown variations in diagnostic performance of HbA1c. Research question: What is the diagnostic sensitivity and specificity of HbA1c in diagnosis of diabetes and prediabetes at Aga …

Comparison Of The Sensitivity Of Biomarker Based Matrix Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (Maldi-Tof Ms) And Conventional Methods In The Identification Of Clinically Relevant Bacteria And Yeast, Ali Abdow Kassim

Master of Medicine in Clinical Pathology

Background: MALDI-TOF MS is an analytical method that has recently become integral in the identification of microorganisms in clinical laboratories. It relies on databases that majorly employ pattern recognition or fingerprinting. Biomarker based databases have also been developed and there is optimism that these may be superior to pattern recognition based databases. This study compared the performance of ribosomal biomarker based MALDI-TOF MS and conventional methods in the identification of selected bacteria and yeast. Methodology: The study was a cross sectional study carried out in collaboration with the Swiss Tropical and Public Health Institute, Switzerland and Mabritec laboratory, Riehen, Switzerland. …

Vitamin D Levels In Black African Adults At The Aga Khan University Hospital Nairobi, Elizabeth Muringa Kagotho

Master of Medicine in Clinical Pathology

Introduction: Vitamin D has been known for centuries for its benefits in bone health. Recent observational studies have however demonstrated its benefits in infectious diseases such as tuberculosis and non-communicable diseases such as diabetes mellitus, cardiovascular diseases and cancer. This has led to a dramatic increase in testing among adults. The cut-offs for vitamin D deficiency have been debated for decades and the current cut off is derived from a Caucasian population. Studies done among black African adults in Africa are few and have shown that vitamin D deficiency ranges from 5-91%. In view of the difference in skin colour, …

The Prevalence Of Malaria And Assessment Of The Uptake Of Malaria Prevention Measures In Blood Donors In Two Regional Blood Transfusion Centres In Kenya, Valerie Magutu

Master of Medicine in Clinical Pathology

Transfusion transmitted malaria is one of the most common transfusion transmissible infections and is a threat to blood safety and malaria control in Sub-Saharan African countries where malaria is endemic. The majority of healthy adults living in malaria endemic areas have some degree of immunity to the disease and an asymptomatic low-level parasitaemia is known to exist in a subset of this population. Blood donors recruited from the population are screened using a donor-selection criteria that includes age, weight, self-declared well-being and measurement of vital signs but not history of recent malaria infection or treatment. The Kenya National Blood Transfusion …

Early Onset Type 2 Diabetes And Associated Risk Factors, Grace Nyambura Kiraka

Master of Medicine in Clinical Pathology

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 cross sectional …

Primary Antiretroviral Drug Resistance Profiles Among Hiv-1 Therapy Naïve Patients In Two Referral Hospitals In Kenya, Simon Onsongo Nyangena

Master of Medicine in Clinical Pathology

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 …

Prevalence Of Nasal Carriage Of Methicillin-Resistant Staphylococcus Aureus In Healthcare Workers At Aga Khan University Hospital, Nairobi, Geoffrey A. Omuse

Master of Medicine in Clinical Pathology

Objective: To establish the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers (HCW) at Aga Khan University Hospital, Nairobi (AKUHN). Background: Healthcare workers are a major reservoir of MRSA and may play a role in the spread of nosocomial MRSA infections. MRSA can cause significant morbidity and mortality. There is both molecular and epidemiological evidence linking HCW to MRSA outbreaks. Method: A cross sectional study conducted between July and December 2010. Nasal swabs were taken from 246 randomly selected HCW from various departments.MRSA was identified using both phenotypic and genotypic methods. Antibiotic susceptibility testing of all …

Prevalence Of Genital Chlamydia Infection In Urban Women Of Reproductive Age, Ruchika Kohli-Kochhar

Master of Medicine in Clinical Pathology

Background: Chlamydia trachomatis is one of the major causes of sexually transmitted infections throughout the world. It is the primary cause for pelvic inflammatory disease, tubal infertility and ectopic pregnancy in females. Most infections are asymptomatic and remain undetected. The burden of disease in the Kenyan population is not well characterised and few previous studies, done in Kenya, show the prevalence of genital Chlamydia infection in sexually active females. There is a need to define prevalence in our local population as a public health need and to determine whether rapid point-of-care testing should be incorporated as a component of sexually …

Immunophenotypic Profile Of Acute Leukemias At Agakhan University Hospital, Nairobi, Beatrice M. Kabera

Master of Medicine in Clinical Pathology

Background: Reliable distinction between AML and ALL is important for the selection of appropriate therapy. The final diagnosis of acute leukemia should be based on clinico-pathological, morphological, cytochemical and molecular cytogenetics data, together with immunophenotypic information. Flow cytometry has become the preferred method for the lineage assignment and maturational analysis of malignant cells in acute leukemias. Immunophenotyping has also allowed the detection of aberrant antigen co expression and the analysis of heterogeneity and clonality of malignant cells in acute leukemias. It is insufficient to merely make a diagnosis of acute leukemia, or even AML or ALL. Further classification is essential …

Detection Of Extended Spectrum Beta Lactamases Genotypes And Their Association With Cephalosporin Susceptibility In Community Acquired Enterobacteriaceae Infections, Daniel W. Maina

Master of Medicine in Clinical Pathology

Background: Infections caused by Extended Spectrum Beta-Lactamases (ESBLs) producing enterobacteriaceae have become a global problem. Initially confined to the hospital set-up, they are increasingly being reported in the community. These infections are often resistant to a wide variety of B- lactams including extended spectrum cephalosporins, with clinical and epidemiological implications for healthcare systems and necessitate surveillance measures based on local data. Local information on the genotypes of ESBLs and their association with cephalosporin resistance in community acquired ESBL-producing Enterobacteriaceae isolates is scanty, hence the need for this study. Aim: To detect ESBLs genotypes and correlate these with susceptibility to cephalosporins …

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

Master of Medicine in Clinical Pathology

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 dead …

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

Master of Medicine in Clinical Pathology

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 …

The Influence Of Antiretroviral Therapy On Qtc Interval Amongst Hiv Patients At Aga Khan University Hospital, Nairobi, Jay Shavadia

Master of Medicine in Clinical Pathology

Aim: To determine the influence of antiretroviral (ARV) therapy on the QTC 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 determine …