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Home > Comparison of Cardiovascular Risk Profiles Amongst Newly Diagnosed Cancer Patients and Non-Cancer Patients at the Aga Khan University Hospital Nairobi

Comparison of Cardiovascular Risk Profiles Amongst Newly Diagnosed Cancer Patients and Non-Cancer Patients at the Aga Khan University Hospital Nairobi

Thesis Info

Author

Sikosana, Majid Lingani-Ncube

Department

Internal Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2015

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728039852

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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 prevalence of hypertension, diabetes, obesity and dyslipidaemia amongst newly diagnosed cancer patients and non-cancer patients (elective surgical patients). Secondary objectives were to estimate and compare the 10yrs predicted occurrence of major cardiovascular events using WHO Afri-E risk score and prevalence of metabolic syndrome in the two populations. Methodology: a Cross-sectional survey of newly diagnosed cancer patients and non-cancer patients in the same institution. Results: The prevalence of hypertension was 23.4 and 31.58% in the cancer and non-cancer group respectively (p-value = 0.62). Diabetes was more prevalent in the cancer group, but this was not statistically different (7.89% vs. 1.32% with a P-value of 0.05). Obesity was more prevalent in the non-cancer group than the cancer group (58% vs. 54%), but this was not statistically significant (p- value = 0.85). The prevalence of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides were higher in the cancer group (76.3%) than the non-cancer group (67.1%), but this difference was not significant (p-value =0.21) .The prevalence of metabolic syndrome was similar in both groups with the cancer group having a prevalence of 30.26% and the non-cancer group 31.58% (p-value=0.86). The AFRI-E CV risk estimations were similar across the various risk stratifications (p-values ranging from 0.32 – 1) Conclusion: There is no significant difference in prevalence of hypertension, diabetes, obesity, but there was a significant difference in the HDL levels (p=0.009), with the cancer group with lower HDL levels, amongst newly diagnosed cancer patients and non-cancer patients at AKUHN. Despite this the prevalence of CVR is appreciable and warrants screening. Similarly, the CV risk scores and prevalence of metabolic syndrome were not significantly different.
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لوکاں اگے اڑ کے ویکھے

لوکاں اگے اڑ کے ویکھے
اکھیں سفنے جڑ کے ویکھے

جیہڑا عشق نوں من دا نئیں
ساڈا ہتھ اوہ پھڑ کے ویکھے

مکھ اوہدے دا نور وے لوکو
چن وی راتی سڑ کے ویکھے

اسیں نہیں اوہدے کولوں ڈردے
نال اساڈے لڑ کے ویکھے

عشق نے انج دی حالت کیتی
ہر اک بندہ کھڑ کے ویکھے

باہروں ہسدا ویکھن سارے
کوئی تے اندر وڑ کے ویکھے

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Seismic Hazard Analysis of Pakistan

This study is focused on the seismic hazard analysis of Pakistan with special emphasis on the development of input parameters. Initially, comprehensive catalogues of both historically reported and instrumentally recorded earthquakes of Pakistan was prepared using a wide range of data sources. Quality of the instrumental earthquake catalogue was assessed by the magnitude of completeness (Mc) using different methodologies, and Stepp’s methodology was found the most adequate. The attenuation relationships were derived by carrying out multiple regression analysis of the macro-seismic and strong motion data. Predicted values of peak ground acceleration (PGA) from these relationships were found in conformity with the observed values of PGA. However, proposed attenuation models somewhat overestimated PGA values in near field region for larger earthquakes (Mw > 7.0). It may be either due to the site nonlinearity effects resulting from high intensity of ground shaking or owe to the factors like geology of the area, fault type, directivity of the fault rupture and other source parameters. A comparison of PGA values assimilated by using Next Generation Attenuation relationships (NGAs) and newly developed attenuation models with the observed values also showed a close proximity, which demonstrates the robustness and applicability of these relations for a wide range of earthquakes. Seismo-tectonic model considering more than 50 faults and 18 seismic source zones provided a future reference for any seismic hazard studies concerning the study area. Deterministic seismic hazard assessment (DSHA) of federal capital and four provincial capitals revealed that Quetta (PGA = 0.35g, vmax = 45cm/sec) was more susceptible to seismic hazard than other cities as Quetta lies near to Chaman Fault, which demonstrated a maximum magnitude potential value of 8.3. Whereas Lahore, capital of the Punjab province, was found to be the least prone to earthquake hazard. Probabilistic seismic hazard assessment (PSHA) of these cities, and on 0.1o x 0.1o grid for 2%, 5% and 10% probability of exceedance in 50, 100 and 250 years in terms of total hazard curves, uniform hazard spectra and seismic hazard maps provided basis for future structural design and analysis. PSHA results also complemented the DSHA results showing Quetta as the most vulnerable to earthquakes. The seismic hazard maps, however, stressed the need to investigate some regions like Quetta and Muzaffarabad- Balakot areas in detail. The design response spectra (DRS) and compatible time histories were also developed for these cities of Pakistan in order to better design and analyze the future and existing structures. Among the methods used for the construction of DRS, the Newmark & Hall method was found the least conservative and International Building Code (IBC) the highest conservative. However, Building Code of Pakistan (BCP) yielded the intermediate values. The spectral acceleration values and PGA values derived from DRS compatible time histories were highest for the Quetta city.