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Home > Investigating Mpm-Iii, Sofa and Delta Sofa Scoring Systems As Predictors of Mortality at a Tertiary Hospital in Nairobi, Kenya: A Retrospective Cohort Study

Investigating Mpm-Iii, Sofa and Delta Sofa Scoring Systems As Predictors of Mortality at a Tertiary Hospital in Nairobi, Kenya: A Retrospective Cohort Study

Thesis Info

Author

Lukoko, Lilian

Department

Anaesthesiology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2018

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728054614

Similar


Background: Despite major advances, management of critically ill patients worldwide is associated with high mortality rates. Assessment of disease severity is crucial in the analysis of ICU mortality. Although a variety of severity of illness scoring systems have been developed for this assessment and validated across Europe and the USA, few studies exist to show support of their utilization in African countries. There is conflicting evidence regarding the most reliable severity of illness scoring system suitable for resource limited countries as their mortality predictive values differ with different populations. SOFA is already in use at the AKUHN ICU and has easily attainable variables, while MPM-III is a simple, non-laboratory test dependent scoring system. Objectives: The primary objective of this study was to compare SOFA and MPM-III severity of illness scoring systems as predictors of mortality in critically ill adult patients admitted to the AKUHN ICU. Secondary objectives were to describe the clinical and demographic characteristics of patients admitted to the AKUHN ICU, to identify factors associated with increased risk of mortality in patients admitted to the AKUHN ICU, to compare MPM-III and delta SOFA scoring systems as predictors of mortality in critically ill adult patients admitted to the AKUHN ICU and to compare SOFA and delta SOFA scoring systems as predictors of mortality in critically ill adult patients admitted to the AKUHN ICU. Primary outcome: ICU mortality Study setting: AKUHN ICU. Study design: A retrospective cohort study. Sample size: Using a formula for determining statistical difference between two areas under receiver operating characteristic curves, a sample size of 543 was used. Study population: Critically ill adult patients admitted to the AKUHN ICU between January 2015 and September 2017. Data collection and entry: The ICU admission register was used to obtain the names and medical records of patients admitted during the study period. A comprehensive review of patients’ files and the AKUHN Electronic Medical Records System (CARE®) was then conducted to extract data as per the data collection tool. MPM-III scores were calculated using an online MPM-III scoring calculator. Data was entered into an MS Excel spreadsheet to form a database. STATA software version 14.2 was used for data analysis. Results: Male patients accounted for 60% of total admissions. The most common reason for admission was respiratory failure at 33%. Medical and surgical admissions constituted 61% and 39% of the total admissions respectively. Mortality rate was 32.4%. Median LOS was 4
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Muslim Religious Militancy: Causes and Cure

Islamic religious militancy is a matter of great concern for the Muslim and the non-Muslim world today. The analysis of the ideology of the militants reveals that they find the legitimacy of their military activities in the ideal of the establishment of an Islamic state to establish the universal rule of Islām, and in the specific interpretations of some Qur’ānic verses, Aḥādīth of the Prophet (r), and also from the establishment of the Islamic state in Madīnah by the Prophet (r), his the military expeditions and those of his companions against their opponents and from the treatment of our historians of the individual military campaigns against the Muslim regimes of their times. The Muslim militants also fight against their Muslim governments on the grounds that they are not the true Islamic governments. The militants do not bother to kill the common Muslim masses, who vote and support such rulers. They take it as collateral damage. The world naturally reacts to this cult, especially the west, being at the helm of the world politics. Not only do the West tries to crush the Islamic militants, across the world, but also, topple the Muslim democratic governments having any ideal of an Islamic Khilāfah. This frustrates the peaceful political activists and strengthens the military activists, further. To end this ongoing and mounting cult of religious militancy, it is necessary to review the specific and traditional interpretations of the academic sources of Islām: Qur’ān, Ḥadīth and Fiqh, regarding the legitimacy of militancy in Islām. Secondly, to remove their misconceptions, it is necessary to engage the militants in dialogue through a counter narrative, which the author tried to present here.

Synthesis of Amino Acids by Click Chemistry

This dissertation is about the synthesis of amino acids i.e. L-alanine, D-phenylalanine, D-homoalanine, D-ornithine and D-lysine using Strecker synthesis. For this purpose, different aldehydes were treated with ammonia to synthesize imino derivatives which are treated with aqueous solution of cyanides. The resultant α-aminonitriles are subjected to acidic hydrolysis to form α-amino acids. Furthermore, the synthesis of nickelocene amino acids was then carried out using click chemistry. Moreover, nickelocene is first treated with acetic anhydride in the presence of phosphoric acid then acetyl nickelocene was obtained. After acetylation of nickelocene the compound acetyl nickelocene was reacted with phosphorous oxychloride in the presence of inert atmosphere at 0 °C then an organometallic novel compound of ethynyl nickelocene was synthesized as a precursor for variety of new compounds. To follow the click chemistry methodology this above titled compound ethynyl nickelocene was further reacted with different azides of amino acids like 3-Azido-L-Alanine, 4-Azido-D-phenylalanine, 4-Azido-D-Homoalanine, 5-Azido-D-Ornithine and 6-Azido-D-Lysine in the presence of CuI as a catalyst to obtained nickelocene amino acids. Click chemistry is a synthetic approach in which small building blocks are used or joining two or more than two reagents to make practical and best reliable chemical transformations. In this synthetic approach chemists synthesize the novel compounds and the precursors for further synthesis with greater yield. The applications of click chemistry are numerous especially in drug discovery, combinatorial chemistry, bioconjugation, and research in DNA and proteomics. The use of click chemistry also extended to find structure activity relationship between different chemicals to produce analogue of chemical libraries. There are different types of click reactions performed by the researchers. Here copper catalyzed cyclo-addition reaction was performed to synthesize the novel organometallic compounds. The coupling reactions in which terminal alkynes and azides are taking part and follow the “Copper catalyzed cycloaddition reactions” methodology in click chemistry. The synthesized nickelocene amino acids (organometallic compounds) were characterized by FT-IR, 1HNMR and 13CNMR respectively. Antimicrobial activity of synthesized bioconjugates was also evaluated against various bacterial and fungal strains such as Staphylococcus aureus, Escherichia coli, Bacillus subtilis, Streptococcus pneumonia, Alternaria alternate, Aspergillus flavus and Aspergillus niger.