Kourosh Afshar


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Graduate Student Supervision

Doctoral Student Supervision

Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.

Bladder and bowel dysfunction in children: an investigation of cardiac autonomic nervous system activity and related therapies (2017)

Bladder and bowel dysfunction (BBD) consists of a prevalent group of conditions presenting mainly with lower urinary tract symptoms. The autonomic nervous system (ANS), comprising mainly of the sympathetic (SNS) and parasympathetic nervous systems (PNS), regulates lower urinary tract function. ANS role in the pathogenesis of BBD in not known. BBD management initiates with education and life-style modification (standard urotherapy or SU). Additionally, adjunctive treatments may be administered. Current treatments are often partially effective, costly, and sometimes associated with side-effects.The overall goal of this dissertation was to describe cardiac ANS activity in children with BBD before receiving any treatments and subsequently after current and proposed adjunctive therapies.Study 1: Forty children with BBD were compared with nineteen healthy controls for the activity of ANS measured via spectral analysis of heart rate variability (HRV). Results demonstrated a significantly lower overall ANS and PNS activity at baseline in BBD group.Study 2: The efficacy of pelvic floor biofeedback in children with BBD was assessed via a systematic literature review and meta-analysis of randomized controlled trials (RCT) which showed no improvement in resolution of urinary incontinence after 6 months of biofeedback compared to other adjunctive treatments.Study 3: Ten children from Study 1 with overactive bladder (OAB) were followed receiving antimuscarinics for approximately 3 months. Results showed a significant reduction in the PNS activity after treatment accompanied by a failure to achieve complete symptom resolution.Study 4: Twenty-three children with BBD were randomized to SU plus diaphragmatic breathing (DB) or SU only in a pilot trial. Results showed a low overall feasibility for proposing DB in controlling symptoms mainly due to low adherence during an approximately 3 months of follow-up. Positive correlations were found between number of DB practices and change from baseline in overall ANS and PNS activity.In summary, BBD was associated with a significantly low overall ANS and PNS activity. There is lack of evidence supporting relative treatment efficacy of biofeedback. Use of antimuscarinics in OAB was associated with further reduction in cardiac PNS activity and the pilot study showed low overall feasibility for proposing DB for three months.

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Master's Student Supervision

Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.

Optical monitoring in kidney transplant (2022)

Background:Currently kidney transplant monitoring relies on clinical and laboratory parameters that may be associated with delayed diagnosis of graft dysfunction. The early detection of allograft abnormal function and institution of the appropriate medical or surgical interventions play a crucial role in allograft survival.Near Infra-Red Spectroscopy (NIRS) has well-known efficacy in non-invasive, continuous and real time monitoring of tissue oxygenation. This novel pilot study intends to assess the feasibility of using NIRS in monitoring transplanted kidney in pediatric recipients.Methods:The primary outcome was to assess the feasibility of NIRS monitoring in evaluating the allograft function, oxygenation, blood circulation and its association with graft function.Twenty patients in two groups (group one and two), participated in this project.NIRS sensor was placed once on the surgical site (upper pole of the allograft) and once at control site for all patients and the data was recorded to measure TOI % (Total Oxygen saturation Index), THI% (Tissue Hemoglobin concentration Index), HHb% (Deoxygenated Hemoglobin) in both surgical and opposite sites. Then we assessed the correlation between Total Oxygen Saturation Index in Surgical Site and Opposite Site with e-GFR, systolic blood pressure, Resistive Index and Hemoglobin.Result:Twenty participants range from 5 to 20 years old with a median age of 12.5 years old completed the study. 20 % of the participants were female, 35 % of the participants were living donor kidney recipients. All the participants tolerated the NIRS sensor and monitoring well, with a valid measurement on surgical and control sites. The study showed that TOI% on surgical site is correlated significantly with e-GFR adjusted for BMI using a linear regression model (P-value = 0.032).Conclusions:NIRS monitoring of transplanted kidney is a feasible and well tolerated method. Our study showed a significant positive correlation between TOISS% and e-GFR. However, the specification restrictions of the available NIRS sensors may limit our ability to get an accurate signal from the target organs in larger patients.Our findings serve as a preliminary benchmark for quality improvement in this field. The process and outcome of this project has identified areas of opportunities to improve this novel approach.

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