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Home > Factors Associated With Cardiac Dysfunction Following Anthracyline-Based Chemotherapy in Adults in a Tertiary Hospital in Nairobi

Factors Associated With Cardiac Dysfunction Following Anthracyline-Based Chemotherapy in Adults in a Tertiary Hospital in Nairobi

Thesis Info

Author

Joseph Odunga Abuodha

Department

Internal Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2019

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728051913

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Introduction: Anthracyclines are known to improve survival in some malignancies, but may also be associated with irreversible cardiotoxicity, which is partly dose dependent. Early detection of cardiotoxicity provides an opportunity for treatment adjustment. Several parameters predict development of clinically manifest cardiac dysfunction. The study aimed to evaluate clinical and echocardiographic parameters which predict development of cardiac dysfunction in a sub-Saharan African population. Methods: Patients with a diagnosis of cancer and receiving anthracyclines at AKUH,N were evaluated if they met eligibility criteria (≥18years at first anthracycline administration, archived baseline echocardiogram, no prior history of heart disease or use of anthracyclines). Patients underwent echocardiographic, baseline clinical , drug therapy, radio-therapy and cardiovascular risk factor assessments. Echocardiographic global longitudinal strain (GLS), left ventricular (LV) ejection fraction and LV volumes were assessed. A relative decline from baseline in GLS of >15%, an absolute decline in LVEF >10 percentage points to <53%, or symptomatic absolute decline in LVEF of 6-10 percentage points to <53% defined LV dysfunction (cases). Factors associated with development ofLV dysfunction were compared between cases and controls (no LV dysfunction). Results: From 14-Oct-2013 to 11-Apr-2019, 504 patients who received anthracyclines were screened. 141 fullfilled inclusion criteria and were analysed (mean age, 47.7 years ± 11.2, Africans 95%, females 85.1%). Breast cancer patients were 82%, lymphoma 12%, sarcoma 5%, and leukaemia 1%. 39 (27.7%) had cardiac dysfunction, 30 of whom fulfilled the GLS criterion. Mean time interval between echocardiograms was 14.3 months (cases 16.4 ± 16.9; controls 14.4 ± 13.2), mean anthracycline dose was 244.7mg/m2 ± 72.2 (cases 254.5 ± 78.7; controls 241 ± 69.6), and mean symptom scores (DASI) were 50.0 ± 13.3 (cases 48.5 ± 13.4; controls 50.5 ± 13.2). Mean cardiotoxic doxorubicin equivalence dose was 236.7 mg/m2 ± 57.4 for cases and 217.3 ± 61.9 for controls [p = 0.033, OR = 1.00 (95% CI: 0.99 - 1.01)]. Cycle intervals, body surface area, body mass index, blood pressure, age, concomitant medication, radiation use and cardiovascular factors were similar. Echocardiographic parameters – E/a ratio and e’ were significantly reduced in cases (E/a 1.02 ± 0.33 for cases vs 1.16 ± 0.36 for controls, p =0.02: e’ 0.10 ± 0.05 for cases vs 0.11 ± 0.05 for controls, p =0.011). Conclusion: This is the first study evaluating early cardiotoxicity in an adult Sub-Saharan population receiving standard dose anthracyclines. The incidence of early cardiotoxicity was 27.7%, which was higher than in previously studied
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اسلام زندہ ہوتا ہے ہر کربلا کے بعد

اسلام زندہ ہوتا ہے ہر کربلا کے بعد
نحمدہ ونصلی علی رسولہ الکریم امّا بعد فاعوذ بااللہ من الشیطن الرجیم
بسم اللہ الرحمن الرحیم
صدر بزم و معزز اساتذہ کرام اور میرے ہم مکتب ساتھیو!
آج مجھے جس موضوع پرلب کشائی کا موقع فراہم کیا گیا ہے ،وہ کچھ یوں ہے:
’’اسلام زندہ ہوتا ہے ہر کربلا کے بعد ‘‘
معزز سامعین!
تاریخ حق و باطل میں خیر و شر کے لاکھوں معرکے ہوئے، ہزاروں شہادتیں ہوئیں۔ اسلام کا اوّلین دور لاتعداد شہادتوں سے لبریز ہے مگر جو شہرت حضرت امام حسین ؓ کو حاصل ہوئی وہ کسی اور کو نصیب نہ ہو سکی۔ آج تک کسی شہادت کو اس قدر شہرت، قبول عام اور ہمہ تذکرہ نصیب نہ ہو سکا جتنا امام حسین ؓ کو ہوا ہے۔ تقریباً ساڑھے تیرہ سو سال گزرنے کے باوجودبھی شہادت امام حسین ؓکا ذکر زندہ و تابندہ ہے۔ حسینیت ہر طبقے میں حق اور یزید یت ہر طبقے میں فتنہ و فساد کی علامت بن گئی ہے۔
حاضرین محفل!
جب یزید تخت نشین ہوا تو اس نے اپنے اقتدار کی راہ میں حائل ہر رکاوٹ کو بڑی بے دردی اورسختی سے دور کرنا شروع کر دیا۔ اسے اپنی راہ میں سب سے بڑی رکاوٹ حضرت امام حسینؓ محسوس ہوئے تھے تو اس نے گورنر مد ینہ کو حکم دیا کہ امام حسین ؓکے پاس جا کر میری بیعت طلب کرو۔ گورنر مدینہ نے حضرت امام حسین ؓکو یزید کا پیغام پہنچایا تو آپ ؓنے صاف انکار کر دیا۔ یہ آپ ؓنے اس لیے کیا کہ آپ ؓ کو اپنے نانا جان حضوراکرمؐ کا فرمان یاد تھا ’’کہ ظالم جابر حکمران کے سامنے کلمہ حق کہنا سب سے بڑا جہاد ہے۔‘‘ تاریخ کے غائر مطالعہ سے جو چیز واضح طور پر ہمارے سامنے آتی ہے وہ یہ ہے...

Impacts of Psychological and Domestic Violence On Women in Pakistan: Problems & Solutions in the Light of Islamic Teachings

Since the creation of woman, she faces many problems in her life. Different societies have their own customs and traditions. And woman faces problems regarding them. Pakistani society has its own influence and civilization which causes many problems of women. In these traditions, one of the bad behaviors is, marriage of woman on wrong time i.e. Late marriage or early time marriage. In the result, at least, she faces Problems regarding dowry, Joint family system, Family disintegration, Childlessness, Propensity to violence, Effects of husband remaining alone from wife etc. On the basis of social divisions in Pakistani family system and depiction of woman issues having effects on herself, the significant and their mediation is very necessary, too. Many of these problems has Psychological impacts on woman in her domestic life. In Pakistani society where woman faces domestic and family problems, there economic problems too pester her which include greed for riches and lack of them both pester her psychologically. In this paper, above mentioned problems of women in Pakistani society has been discussed in the light of Islamic teachings.

Characterization of Loquat Eriobotrya Japonica Lindl. Genotypes Cultivated in Pakistan on the Basis of Morpho-Physical Traits and Molecular Markers

Loquat (Eriobotrya japonica Lindl.) is an important but ignored fruit crop of Pakistan for which no research work has ever been reported previously inside the country. There is no standard or identified loquat cultivar available to the growers for cultivation in the loquat growing pockets of Pakistan. Generally, the farmers grow their orchards through seeds. As a result, most of the loquat orchards do not possess the plants with uniform fruit characters and fruit is not of good quality. Previously no work has been reported regarding description of the loquat genotypes in Pakistan. The present study was, therefore, carried out to evaluate and characterize the available genotypes in the main loquat growing areas of Pakistan and to determine the genetic diversity among these genotypes. For this purpose, 9 sites were selected in the main loquat growing areas of Pakistan. Forty two genotypes were identified, which were compared on the basis of morpho-physical traits. Significant differences were observed with reference to various characteristics among different genotypes. Fruit weight of the genotypes ranged from 9.54 g (in HW4) to 47.84 g (in TB15). Range of flesh seed ratio was from 1.67 (in HW5) to 3.05 (in TB8). Minimum yield per tree was recorded as 25.85 kg (in TB15), while it was maximum (89.87 kg) in TB7. Correlations among some traits were also observed. Moreover, RAPD analyses of the genotypes were performed. Five RAPD primers gave reproducible results and generated 47 polymorphic bands. According to the dandrogram, two main groups of the loquat genotypes were identified with a linkage distance of 33%. For most of the locations, grouping of the genotypes was in accordance with the geographical locations. Out of the three genotypes from Mardan, one falls under the first group and the other two under the second group. The maximum number of genotypes (15) was identified at Takht Bhai, two of them belonged to the first group and 13 to the second group. Genotypes with good characteristics i.e. better yield, higher fruit size and weight, less number of seeds per fruit and higher flesh seed ratio can be recommended for further multiplication and introduction to the other loquat growing areas which would increase the income of farming community. The study also recommends establishing germplasm units in Punjab and NWFP and pooling all these genotypes for future strategies and breeding programs including selection, introduction, hybridization and mutation breeding. The present study would also be helpful for the documentation, management, and conservation of the loquat genetic resources of Pakistan.