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Diagnostic Utility of Who Defined Sepsis Syndromic Criteria With Procalcitonin in Identification of Sepsis in Children With Suspected Infections

Thesis Info

Author

Samuel Owuor Akech

Department

Paediatrics and Child Health (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

1676728044625

Similar


Title: Diagnostic Utility of WHO Defined Sepsis syndromic Criteria with Procalcitonin in Identification of Sepsis in Children with Suspected Infections Background: Bacterial infections are a major cause of morbidity and mortality in children but accurate and timely diagnosis remains a challenge to the frontline clinicians. Cultures of sterile bodily specimens are considered the gold standard but are insensitive and results are delayed. Procalcitonin (PCT) has recently emerged as a biomarker with high sensitivity and specificity making it superior to culture based techniques performed in non-ideal circumstances which prevail in resource poor settings. This study investigated the diagnostic utility World Health Organization (WHO) defined criteria for sepsis in diagnosis of bacterial sepsis using procalcitonin (PCT) as the “gold standard”. Methods: This was a prospective survey conducted between July to October 2014 whose primary objective was to determine the sensitivity, specificity, and predictive values of WHO definitions of sepsis syndromes using procalcitonin as the ‘gold standard’ in children with suspected infections. Our secondary objective was to investigate association between PCT elevation and severity of disease and other markers of sepsis. The study was conducted at the paediatrics casualty of the Aga Khan University Hospital, Nairobi (AKUHN) and enrolled children aged >30 days and ≤15 years with suspected infection. This was defined as presence of systemic inflammatory response syndrome (SIRS) (abnormal temperature (>38.5°C or12hours. Children with obvious causes of SIRS such as mechanical/surgical trauma, severe burns, cancer, and without parental/guardian consent were excluded. A standard clinical proforma that allowed classification into various WHO clinical sepsis syndromes for enrolled patients was fulfilled by attending clinician. Blood sample of 0.5ml was collected and PCT test done. Sensitivity (Sp), specificity (Sn), negative and positive predictive values (NPV, PPV), and positive and negative likelihood ratios (LR+, LR-) were calculated for the WHO syndromic definitions. The gold standard for bacterial sepsis was defined as PCT level ≥0.5μg/l. Logistic regression was done and odds ratios calculated to test for association between procalcitonin and disease severity/clinical signs. Kaplan Meier survival analysis was done to compare duration of hospitalisation in various sub-groups. Results: A total of 231 children were enrolled and 22% (51 children) fulfilled criteria for WHO sepsis syndrome. WHO sepsis syndromes definitions had low Sn, 56.9% (95% CI; 50.5%, 63.3%) and Sp, 66.7% (95% CI; 60.6%, 72.8%) for diagnosis of sepsis. PPV was 32.6% (95% CI; 26.5%, 38.6%) and NPV was 84.5% (95% CI; 79.8% 89.2%). Presence of WHO
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ظفر احمد صدیقی

ظفر احمد صدیقی مرحوم
( ڈاکٹر محمد اشتیاق حسین قریشی)
۴؍ اکتوبر ۱۹۸۰؁ء کو جناب ظفر احمد صدیقی وکیل، سکریٹری دینی تعلیم کونسل کا انتقال اپنے آبائی وطن راما بھاری تحصیل بسواں ضلع سیتاپور میں ۳۰:۷ بجے صبح کو طویل علالت کے بعد ہوگیا، دفتر دینی تعلیمی کونسل لکھنو میں وہ حضرت مولانا علی میاں صاحب کے ایماء پر ۵۹؁ء سے مقیم تھے، یہ ایک طرح سے ان کا وطن ثانی بن گیا تھا، اپنی وفات سے ۴۸ گھنٹے پہلے اس حال میں رخصت ہوئے تھے کہ انہیں ہوش نہیں تھا، بلڈ یوریا کی وجہ سے ایک ہفتہ سے غفلت تھی، احباب اور رفقاء نے اسی وقت یہ سمجھ لیا تھا کہ برسوں کا یہ تھکا ہوا مسافر اور ساتھی اب لکھنؤ واپس نہیں آئے گا، سیتاپور سے فون پر اطلاع ملی، وہ سب سے جدا ہوکر اﷲ کو پیارے ہوگئے، ان کی اہلیہ کا انتقال سال بھر پہلے ہوچکا تھا، اولاد کوئی نہیں تھی، بھتیجوں کو اولاد سمجھتے رہے، جن کو اپنی نگرانی میں تعلیم دلائی، ان کے حقیقی بھائی کا قیام رامابھاری میں ہے، جہاں ان کا خاندان صدیوں سے آباد ہے۔
ظفر صاحب نے تعلیم مسلم یونیورسٹی میں پائی، ان کا قیام میکڈانلڈ ہوسٹل میں تھا، تعلیم کے بعد سیتاپور میں وکالت شروع کی ان کا شمار وہاں کے کامیاب وکیلوں میں تھا، ۴۷؁ء سے پہلے مسلم لیگ سے وابستہ رہے، تبلیغی کاموں سے بھی شغف رکھا، لیکن جب قاضی محمد عدیل عباسی مرحوم نے ۵۹؁ء میں بستی میں بچوں کی تعلیم کے سلسلہ میں کنونشن کیا اور وہاں یہ فیصلہ ہوا کہ اس سلسلہ میں مستقل کام کی ضرورت ہے، تو حضرت مولانا علی میاں صاحب کے ایماء پر ظفر صاحب نے اپنی کامیاب وکالت چھوڑ دی اور دینی تعلیمی کونسل کے کاموں کے لئے اپنے کو وقف کردیا، پھر ان کو ایسی...

IMPLEMENTASI TEORI BEHAVIORISME TERHADAP PEMBIASAAN MEMBACA ASMAUL HUSNA

The theory of learning behaviorism observe the change of one's behavior as a result of past experience. This theory emphasizes that the behavior is a result of the interaction between the stimulus and the response. This theory does not recognize the presence of innate intelligence or derivatives, but rather recognizes that intelligence is influenced by environmental factors. This theory can be applied in learning that requires practice, habituation and repetition. Therefore, to introduce and understand about Asmaul Husna, the theory of behaviorism can be applied in the process of habituation. The recitation of Asmaul Husna is very much contained in its role. Among them to introduce and hang students about Asmaul Husna, so students will feel closer to God if they often apply Asmaul Husna readings and will always feel that everything we do is supervised by God. Like the example of one of the traits contained in Asmaul Husna.  Based on the discussion, the problem raised is how to implement behaviorism theory to the habituation of Asmaul Husna reading.

Phytosociological and Ethnobotanical Studies of Mohmand Agency

This thesis explored phytosociology, ethnobotany and conservation status of the flora of Mohmand Agency (FATA, Pakistan). Flora from 10 selected sites comprising 170 plant species was distributed among 144 genera and 49 families. Among angiosperms, Asteraceae and Poaceae were the two leading families, with 22 species each, followed by Brassicaceae and Fabaceae with 11 species each. Moreover, Lamiaceae, Boraginaceae and Amaranthaceae were some of the other important families. Dicots were most dominant with 141 species from 118 genera and 43 families; monocots were 27 species from 24 genera and 4 families. Gymnosperms were very sparsely distributed in the area with a representation of only 2 species (Ephedra intermedia and Pinus roxburghii). It is worth mentioning that Astragalus was the most represented genus with 4 species. Vegetation of the area was classified in 40 different plant communities on the bases of altitude and seasonal variation. Based on diversity indices Artemisia-Brachypodium-Aristida and Aristida-Hordeum-Phalaris were the most diverse communities. Species Richness evaluation of the communities indicated that Artemisia-Brachypodium-Aristida and Dodonaea-Rumex-Acacia communities were having the highest species-richness-values (3.1 and 2.86 respectively). Maturity Indices of all the communities were calculated which showed that Dodonaea-Brachypodium-Hordeum and Hordeum-Medicago-Peganum communities were the most mature communities in the research area with MI values of 51.7 and 50 respectively. All the communities were dissimilar as none of the two communities had a similarity index equal to or more than 65 percent. Life form classification of flora indicated that therophytes were dominant with 97 (57%) species followed by nanophanerophytes and hemicryptophytes (21=12.4% species each). Chamaephytes (17=10% species), geophytes (7=4% species), microphanerophytes (3=1.8% species), mesophanerophytes and megaphanerophytes (2=1.2% species each) were also reported from the area. Leaf size assessment of the flora revealed that it was dominated by nanophylls (74=43% species) and microphylls (47=27.6% species). Leptophylls (33=19.4% species), mesophylls (11=6.5 species) and aphyllous plants (4=2.4 species) were also found in the area. Only 1 species—Nannorrhops ritchiana (0.6%)—was found to be megaphyllous. Phenological behavior of the plants was studied round the year. It was observed that March-to-June time period of the year was characterized by rich flora and most of the species were in active stage of their life. April was characterized by high flowering spell, with 41% flora in flowering condition. Most of the species were in fruiting condition during the month of May. January was with most of the species (63%) in dormant/post reproductive phase of their life cycle. 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Average biomass production was calculated and was found to be 19.6g/m2. Conservation status of the species was evaluated, using IUCN criteria, enumerating 13 species in endangered category, 32 in vulnerable, 82 in rare and 38 species in infrequent category. No species was reported in dominant category indicating poor floristic health of the area. Biotic and abiotic stresses are responsible for the present status of the flora. Grazing (which is directly related to the palatability of vegetation) and cutting are the two major biotic stresses in the area. Plant species were divided into 4 classes of palatability: highly palatable, moderately palatable, less palatable and non-palatable. Results revealed 68 (40%) species to be highly palatable, 39 (22%) moderately palatable, 25 (14%) less palatable and 38 (22%) species non-palatable. Five plant species comprising Caralluma tuberculata, Fagonia indica, Sageretia thea, Monotheca buxifolia and Ziziphus mauritiana were screened for elemental and nutritional contents. C. tuberculata was with relatively high amount of NPK (Sodium, Phosphorus and Potassium) followed by S. thea and Z. mauritiana. Micronutrient study indicated that Zn and Co was found in highest concentration (57ppm and 2.5ppm respectively) in M. buxifolia. Fe, Pb and Cr concentrations were highest (514ppm, 1.2ppm and 9.3ppm respectively) in F. indica. Carbohydrates, proteins, fats, fibers and ash contents of the selected species were analyzed. S. thea and M. buxifolia were with highest concentrations (57% and 51% respectively) of carbohydrates. M. buxifolia and C. tuberculata were having 3.5 and 3.1% protein contents and 1.2 and 1.2 % fats contents respectively, making them the highest fats and proteins containing plants. S. thea and M. buxifolia were the plants with highest relative ash contents (11.7% and 11.6% respectively) followed by F. indica and C. tuberculata (9.8 and 9.5% respectively). The plants were found to have enough nutrients for the foraging animals and there is no need of external augmentation of nutrients. Soil samples were collected from 10 study sites and were screened for different physicochemical attributes. The results showed that, to a greater extent, the soil of the area is silt loam in texture with pH ranging from 7.4 to 8.4 mol/L i.e. slightly alkaline.