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Prevalence of Abnormal Aminoglycoside Trough Levels in Children With Clinically Suspected Gram Negative Infections at the Aga Khan University Hospital, Nairobi

Thesis Info

Author

Kihurani, Isaac N.

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

2010

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728059890

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Background: Aminoglycosides are commonly used in the treatment of severe gram-negative infections. Their use is associated with substantial risk of toxicity and hence need to monitor therapeutic drug levels. The prevalence of abnormal aminoglycoside trough levels in hospitalized children in our local setting has not been determined thus putting into question the cost benefits of providing therapeutic drug monitoring services in our resource poor settings. Objective: To determine the prevalence of abnormal aminoglycoside trough levels in children below the age of 12 years with clinically suspected gram negative infections at the Aga Khan University Hospital, Nairobi. The secondary objective was to determine if glomerular filtration rate (GFR) estimation using Schwartz formula correlates with drug trough levels in children on aminoglycoside therapy. Methods: Children aged 1 day up to 12 years started on aminoglycoside therapy with either gentamicin or amikacin were identified in this hospital based cross-sectional survey that was undertaken at the Aga Khan University Hospital, Nairobi over a period of six months. Aminoglycoside drug trough levels and serum creatinine measurements were done in 81 patients at 24hours after initiation of aminoglycoside therapy. GFR was calculated using Schwartz formula for all the serum creatinine values obtained. Data analysis: Data accrued were analysed using Stata Data Analysis and Statistical software. The prevalence of abnormal aminoglycoside trough levels was calculated. The Pearson correlation coefficient was calculated between the drug trough levels and estimated GFR. The prevalence, sensitivity, specificity, positive and vi negative predictive values as well as likelihood ratios, and hence accuracy of estimated GFR in predicting for abnormal aminoglycoside trough levels was also calculated. The area under the receiver operating characteristic (ROC) curve was also determined. Results: A total of eighty one participants were recruited into this study with a median age of three days, 48.2% of whom were males and 51.8% female. The prevalence of abnormal aminoglycoside trough levels in children below the age of 12 years with clinically suspected gram negative infections admitted at the Aga Khan University Hospital, Nairobi was 4.9% (95% CI 1.4% to 12.2%). There were no reported adverse outcomes in any of the children with abnormal drug trough levels upon follow-up. The strength of the association between aminoglycoside trough levels and glomerular filtration rate was found to be weak with Pearson correlation co-efficient of -0.342. The sensitivity and specificity of estimated GFR in predicting for abnormal aminoglycoside trough levels was 25.0% and 98.7% respectively. The
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نور الدین بیرسٹر

مولانا شاہ معین الدین احمد ندوی/نورالدین
حیدرآباد سے واپس پہنچتے ہی مولانا شاہ معین الدین احمد صاحب ندوی اورجناب نورالدین صاحب بیرسٹر کے حادثۂ وفات کی خبراچانک سُنی توجی دھک سے ہوکر رہ گیا اورقلب ودماغ پرگویا بجلی گرپڑی۔ شاہ صاحب ندوۃ العلماء کے گل سرسبد، نہایت پختہ قلم مصنف، تاریخ اسلام کے وسیع النظر محقق، اردو زبان کے ادیب اورسوباتوں کی ایک بات یہ ہے کہ مولانا سید سلیمان ندوی کے صحیح جانشین اوران کے قائم مقام تھے، اوراس میں کوئی شبہ نہیں کہ تقسیم ہند کے بعد سے اب تک انہوں نے دارالمصنفین کے علمی وقار اورمرتبہ کو قائم و برقرار رکھا اور ملک کے نہایت سخت طوفانی دور میں بھی اس باغیچۂ علم وادب کی جس طرح حفاظت اوردل وجان سے اس کی آبیاری کی وہ ان کی قبائے فضل کا تکمۂ زریں ہے۔ علم وفضل اورتحقیق وتصنیف کے علاوہ اخلاق وعادات اورکردار وعمل کے اعتبار سے بھی وہ سلف صالحین کانمونہ تھے نہایت مخلص،بے لوث، عابد و زاہد، خندہ جبیں،شگفتہ طبع،ملنسار اورمتواضع اورمرنجان ومرنج۔
موخرٔ الذکر ہندوستان کے نامی گرامی بیرسٹر تھے سپریم کورٹ کے ممتاز قانون دانوں میں ان کاشمار ہوتاتھا۔ قومی اورملی کاموں میں پیش پیش رہتے تھے۔ طبیعت قلندرانہ پائی تھی۔ایک برس دلی کے مئیر ( MAYOR)اوراس حیثیت سے بہت کامیاب رہے تھے، دوسرے برس انہوں نے میئر ہونے سے انکار کردیا۔مسلم یونیورسٹی علی گڑھ کی وائس چانسلر شپ کئی مرتبہ پیش کی گئی لیکن انہوں نے قبول نہیں کی، وہ اگر چاہتے تومرکزی کابینہ میں شمولیت اورکسی ملک کی سفارت کاحصول اُن کے لیے معمولی بات تھی، لیکن کبھی ان چیزوں کی طرف انہوں نے آنکھ اٹھا کر نہیں دیکھا۔ بیرسٹر بہت اونچے درجے کے تھے، وہ بہت آسانی سے کروڑ پتی بن سکتے تھے، لیکن عمر بھر کرایہ کے مکان میں رہے، اور یوں بھی بہت سادہ...

اﻷداء اﻟﻤﺄﻣﻮر ﺑﻪ و ﺗﻄﺒﻴﻘﺎﺗﻪ اﻟﻔﻘﻬﻴﺔ

In the Islamic Law i. E. Quran and Sunnah the above mentioned topic has been discussed clearly and repeatedly to avoid any ambiguity in dealings in our daily life and agreements made between two parties or governments national or international levels. After intensive study I discussed and elaborated the said issue referring to the Qura’nic verses and sayings of the Prophet (SAW). The matter is of great importance; hence the Muslims Jurists have also given their valuable opinions in accordance with the Islamic Law which have been incorporated also to solve the issue. If we act upon these verdicts, we will be able to select the best among ourselves and form an ideal government and will discharge our duties honestly, and eventually our every act will show our responsibility to perform our duties and to give due share to the right person.

Decentralization and Sources of Interprovincial Growth Dependency and Disparities: A Case Study of Pakistan

Regional (provincial) growth inequalities and deprivation among provinces of Pakistan is one of the hot issues. It is a general perception that small provinces are neglected in the development process, while main focus of development policies was on large provinces. This study the first of its kind, which analyzes the relationship among the growth rates of provinces in Pakistan. It also explores sources of regional inequalities among provinces. In this context, the role of monetary and fiscal polices, are also explored. To understand, the nature of economic relationships and regional pattern of growth among provinces, the study Applied Engle Granger (EG) cointegration technique. The use of EG enables to analyze inter-provincial growth rates on one to one basis. The study has estimated 144 co-integrating equations to explore the dynamic relationship between GDP, agriculture, industry and services sectors of Pakistan and in its four provinces. Empirical evidences are drawn within sectoral relationship and among the four provinces of Pakistan. The results reveal that GDP growth rate of Punjab and Sindh provinces complement each other, in the development process. However, it revealed that the deprived provinces of Balochistan and KPK growth rates depend upon Sindh and Punjab. The sectoral cointegration analysis indicated that linkages across sectors and provinces are weak; among poor provinces. The findings confirm that there is a significant sectoral relationship and integration between relatively developed provinces of Punjab and Sindh. Their growth benefited each other, across provinces. This may be due to the fact that planning in Pakistan, before the 18th Amendment in the constitution, was centralized, and polices were focused on sectoral development rather than regional development; while regional income inequalities were ignored which led to provincial deprivation and inequalities. Further, the results of the study also supported that the growth of agriculture and industry, in each province, significantly depends on the growth of the services sector of the same province, as well as, on the service sectors of other provinces. The study has also estimated the impact of monetary and fiscal Policy on inter provincial growth differentials. For this, purpose panel data was utilized by applying fixed effect model. The analysis indicated that fiscal policy helped to reduce the regional growth disparities in Pakistan, whereas monetary policies enrage the situation of increasing income inequalities in the provinces. The study indicted high variations in the level of financial development across provinces, which may be one of the reasons for less development in the poor provinces like Balochistan and KPK. Lastly, an important finding of the study is that the incidences of terrorism and electricity load shedding, have augmented the regional growth disparities among provinces and in Pakistan. The shortfall in electricity has most affected the large scale manufacturing sector of Sindh, whereas the terrorism mostly affects KPK and Balochistan, which further fueled deprivation of the neglected province. The study suggests that planning and policy making should use from bottom up approach to address the above cited emerging economic issues. Provinces be empowered to have lion’s share in financial exchequer and economic decision making. The central planning body had members from each province who had responsibility to keep check on regional equity and disparities. The very concept of the institution has lost, since government servants (CSP officers) are serving on these positions now and they hardly play their role in this respect. It is recommended that the central planning body (Planning Commission) and Central bank should play their role in curtailing regional income inequalities and deprivations. There is an earnest need to integrate all provinces in to the main framework of economic development, on equity basis. Besides, although there is a right step of NFC award, which provides more resources to provinces but still there is a need to strengthen it more in terms of more economic power to provinces if they have to be integrated. Special development programs are needed to integrate relatively underdeveloped provinces of Balochistan and KPK; if at all regional equity has to be maintained and these provinces have to bring out of the sense of deprivation.