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Home > Prevalence of Metastatic Disease in Newly Diagnosed Breast Cancer Patients As Seen on Contrast Enhanced Computed Tomography of the Chest, Abdomen and Pelvis at the Aga Khan University Hospital, Nairobi.

Prevalence of Metastatic Disease in Newly Diagnosed Breast Cancer Patients As Seen on Contrast Enhanced Computed Tomography of the Chest, Abdomen and Pelvis at the Aga Khan University Hospital, Nairobi.

Thesis Info

Author

Obala, Gregory

Department

Imaging and Diagnostic Radiology (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

1676728062059

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Introduction: Breast cancer patients have traditionally been screened for occult metastases with abdominal ultrasound, chest radiography and bone scan although the use of modern tests with greateraccuracy such as computed tomography (CT), 2-[fluorine-18] fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) and Magnetic resonance (MR) imaging is on the increase. The use of contrast enhanced CT (CECT) in the staging of patients with newly diagnosed breast cancer has increased greatly in clinical practice in view of it being widely available and relatively cheapwhen compared to other modalities such as MRI and PET imaging. The clinical utility of routine staging CECT is yet to be fully defined as there is no agreement between protocols on what clinical stage, size of tumour or extent of lymph node involvement that should trigger the use of advanced imaging such as staging CECT or even MRI/PET at time of breast cancer diagnosis. Objective: This study was done to determine the prevalence of distant metastasis as seen on staging CECT done at time of diagnosis in patients with new diagnosis breast cancer. Study design: Cross sectional study with data gathered retrospectively. Methods: Results of CECT examinations done for staging of patients with new diagnosis breast cancer were reviewed retrospectively to determine the prevalence of metastatic disease at time of diagnosis. CECT examinations done between January 2014 andJanuary 2017 at Aga Khan University Hospital in Nairobi (AKUH, N) were used in this study. Additional data were gathered from patient files and pathology records. Results: The overall prevalence of distant metastasis was 14.8 % in the 183 patients recruited in this study. Using tumour size and nodal status staging (AJCC 7thEdition), 38 patients were classified as stage I (21%), 89 patients were classified as stage II (49%) and 56 patients (30%) were classified as stage III. Following the results of CECT,noneof the 38 patients at stage I were upstaged while6 of the 89 patients (7%) and 21 of the 56 (37.5%) at stage II andIII respectively were upstaged to stage IV breast cancer. Conclusions: The overall prevalence of distant metastasis was 14.8 % in the 183 patients recruited in this study. The general practice of using staging CECT to screen for metastasis in patients with newly diagnosed breast cancer was useful in patients with locally advanced breast cancer (stage III) and not useful in those with stage I disease. 7% of patients were upstaged from stage II breast cancer to
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مفتی محمد عبداﷲ ٹونکی

مفتی محمد عبداﷲ صاحب ٹونکی

            اخبارات سے یہ خبر معلوم ہوچکی ہوگی کہ جناب مولانا مفتی محمد عبداﷲ صاحب ٹونکی نے ۷؍ نومبر ۱۹۲۰؁ء کو بعارضۂ فالج بھوپال میں انتقال کیا، مفتی صاحب مرحوم عربی درسگاہوں کی قدیم تعلیم کے بہترین نمونہ تھے، ہندوستان کے مشاہیر علماء میں ان کا شمار تھا، وہ ادب میں مولانا فیض الحسن صاحب اور دینیات میں مولانا احمد علی صاحب محدث کے شاگرد تھے، مولانا فیض الحسن صاحب کے انتقال کے بعد اورینٹل کالج لاہور کی پروفیسری کی جگہ ان کو ملی اور ان کی عمر کا بڑا حصہ اسی درسگاہ میں گزرا، اخیر زمانہ میں وہ دارالعلوم ندوہ کے مدرس مقرر ہوئے تھے اور اس کے بعد مدرسۂ عالیہ کلکتہ کے صدر مدرس ہوئے اور یہیں سے بیمار ہوکر اپنے صاحبزادہ جناب مفتی انوارالحق صاحب ایم، اے ناظم و مشیر تعلیمات بھوپال کے پاس گئے تھے جہاں انہوں نے وفات پائی، غالباً وفات کے وقت مفتی صاحب مرحوم کی عمر ستر (۷۰) کے قریب ہوگی، تعلیمی خدمات کے علاوہ مفتی صاحب کا بڑا کارنامہ انجمن مستشار العلماء لاہور ہے، جو ایک قسم کا دارالافتاء ہے۔ مرحوم نے بعض عربی کی درسی کتابوں پر حواشی بھی لکھے تھے۔ ان کی وفات سے علماء کی صف میں ایک ایسی جگہ خالی ہے جس کے بھرنے کی اب آئندہ امید نہیں۔

(سید سليمان ندوی، نومبر ۱۹۲۰ء)

 

Linguistic Expressions of Prophet Muhammad (ﷺ) As a Miracle in Arabic Language: A Study of Linguistic Miracles of Prophet Muhammad

Arabian Peninsula was famous for its language expertise and linguistic expressions at the time of Prophet Muhammad (ﷺ). The poets and language experts would spend most of their lives to attain excellence in Arabic language and literature. It was during such time that a man named Muhammad (ﷺ) emerged, whose linguistic expression was remarkable, accurate and amazing. He was also quite familiar with the dialects and accents of every tribe of Arabia. It was the surprising effect of this linguistic excellence that people tagged him with different titles such as Poet, Sorcerer, Kāhin (soothsayer), Majnūn (One possessed by Jinn), and insane man with insane message. Allah Almighty revealed Qur’ānic verses not only to answer such allegations but also entrusted him to present commentary of the Holy Qur’ān to the people who would called him illiterate. This article will try to find out the Qur’ānic commentary on the linguistic expressions of Prophet Muhammad (ﷺ) as a miracle of revelation. The method of research is descriptive analytical and historical. The discussion of verses of Qur’ān and the explanations of the experts of Qur’ān through the comments of orientalists have been included to support the arguments. First Part of the paper discusses status of Prophet Muhammad (ﷺ) as an illiterate man with his remarkable linguistic expressions of Qur’ān due to which he was awarded different titles such as poet, sorcerer and insane. The second part explains the Qur’ānic response to accusations on Prophet (ﷺ) raised by the opponents. In the third part, some intellectual arguments of Qur’ān and opinions of orientalist have been discussed to support the Qur’ānic responses in favor of linguistic expressions of an “Ummi” Prophet Muhammad (ﷺ) which is followed by findings and conclusion of the whole discussion.

A Randomised Controlled Trial Comparing Haemodynamic Stability in Elderly Patients Undergoing Spinal Anaesthesia at L5, S1 Versus Spinal Anaesthesia at L3, 4 at the Aga Khan University Hospital, Nairobi

Background: Spinal anaesthesia is a routinely used anaesthetic technique for elderly patients undergoing operations involving the lower limbs, lower abdomen, pelvis and the perineum. Spinal anaesthesia has several advantages over general anaesthesia and these include stable haemodynamic variables, less blood loss, less post operative pain, faster recovery time and less post operative confusion. However, despite these advantages, the sympathetic blockade induced by spinal anaesthesia can result in hypotension, bradycardia, dysrhythmias and cardiac arrests. Conventionally, spinal anaesthesia is performed at the level of L3,4 interspace; with a reported incidence of hypotension in the elderly ranging between 65% and 69%. A possible strategy for reducing spinal induced hypotension would be to minimize the peak block height to as low as possible for the planned procedure. The purpose of this study was to investigate the decrease in mean arterial pressures and change heart rates from baseline values (haemodynamic stability) of elderly patients undergoing spinal anaesthesia performed at the level of L5, S1 compared to the conventional level at the L3, 4 interspace. Objective: To determine the difference in haemodynamic stability between elderly patients undergoing spinal anaesthesia at L5, S1 interspace compared to elderly patients undergoing spinal anaesthesia at L3, 4. Study design: A randomized single blinded controlled trial Methods: Thirty two elderly patients scheduled for lower limb or pelvic surgery under spinal anaesthesia were randomized into 2 groups (control group and intervention group) using a computer generated table of numbers. Control group; received 2.5 mls 0.5% hyperbaric bupivacaine injected intrathecally at the L3, 4 interspace Intervention group; 2.5mls 0.5% hyperbaric bupivacaine injected intrathecally at the L5, S1 interspace Results: The two groups had similar baseline characteristics in age, sex, body mass index and use of anti-hypertensive medications. There was 68.75% proportion of hypotension in the control group and 75% in the intervention group. The difference was not found to be statistically significant (p= 0.694). During the study period, there were 106 episodes of hypotension, out of which, 65 were in the control group and 41 in the intervention group (p=0.004). This difference was statistically significant.Linear regression analysis of the decrease in mean arterial pressures (MAP) showed a higher decrease in MAP in the control group (p 0.018). There were more crystalloids used in the control group (1006mls ± 374) than in the intervention group (606mls ±211) with a p< 0.0001. There was no difference in the amounts of vasopressors used between the two