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Home > The Incidence of Early Upper Extremity Disability After Axillary Surgery in Patients With Early Breast Cancer

The Incidence of Early Upper Extremity Disability After Axillary Surgery in Patients With Early Breast Cancer

Thesis Info

Author

Mbaabu, Karen

Department

General Surgery (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2014

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728071905

Similar


Background: The treatment of early breast cancer includes surgical removal of the tumor as well as evaluation of the axillary lymph node status. Axillary lymph node surgery, both sentinel lymph node biopsy and axillary lymph node dissection, is associated with upper arm morbidity that has been relatively understudied. The impact of this upper arm limitation has a direct effect on the patients’ quality of life. Determining the degree to which our patients experience this disability will enable the breast cancer unit to develop a prospective surveillance rehabilitative program. Objectives: The objectives of the study were to determine the occurrence of upper extremity disability in patients with breast cancer undergoing axillary dissection, the relative risk of developing the above disability as quantified by a DASH score. Methods: A cohort study was performed on 2 arms of patients; grouped into a ‘late’ arm, who had undergone axillary surgery up to 2 years prior, and an ‘early’ arm, comprising of patients who were recruited after they had undergone axillary surgery up to 6 weeks prior. Data was collected using the DASH® questionnaire. Other variables including age and use of chemotherapy were collected. Data was analyzed using SPSS to correlate the extent of arm disability with specific activities on the DASH questionnaire. Outcomes: The occurrence of upper extremity impairment with specific domains of the DASH score is presented. Results: There was significant upper extremity limitation as measured by the DASH score, which ranged between 50 and 54 for both cohorts studied. The main disability domain comprised of neuropathic symptoms. There was no difference in the DASH scores between patients who underwent sentinel lymph node biopsy and those who had axillary lymph node dissection. Conclusion: Patients undergoing treatment for early breast cancer experience limitations with their upper arm function. Interventions such as targeted rehabilitation program need to be offered as part of patient holistic care. Further longer term studies are required to quantify upper arm symptoms in this population
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پروفیسر ضیاء الحسن فاروقی

آہ! پروفیسر ضیاء الحسن فاروقی
پروفیسر ضیاء الحسن فاروقی کے انتقال کی خبر یکم اگست کو ۱۲ بجے شب میں سنی تو یقین نہیں ہوا، علی الصباح جناب عبداللطیف اعظمی کو فون کیا گیا تو انہوں نے بتایا کہ یہ حادثہ جاں کاہ ۳۰؍ جولائی کی شب میں پیش آیا اور ۳۱؍ کو دوپہر بعد تدفین ہوئی، میرے لیے یہ خبر ناقابل برداشت تھی، اپنے دل کا بوجھ ہلکا کرنے کے لیے ان کے دونوں صاحبزادوں کو خطوط لکھے، اس پر بھی تاب لائے نہ بنی تو ۸؍ اگست کو دہلی ان کے دولت کدہ پر تعزیت کے لیے حاضر ہوا، لیکن اب بھی تسکین دلِ محزوں نہیں ہورہی ہے اور بے چینی اور اضطراب کا وہی عالم ہے۔
مجھ سے پوچھو نہ مزاج دل نا شاد ابھی
میرے نغموں میں ہے کچھ تلخی فریاد ابھی
ابھی ۱۸؍ جولائی کو مجلس تحقیقات و نشریات لکھنو کے جلسے میں ان سے ملاقات ہوئی تھی تو میں نے عرض کی تھی کہ اعظم گڈھ تشریف لے چلیں، پہلے تو حسب عادت مسکرائے پھر کہا ۲۰؍ کودہلی واپسی کا ریزرویشن کراچکا ہوں، میں ڈھائی بجے دن میں ان سے رخصت ہونے لگا تو یہ کہہ کر مجھے روکنا چاہا کہ ’’ارے بڑی سخت دھوپ ہے‘‘۔
ٹھہر بھی جا در ساقی پہ دو گھڑی کے لیے
تمام عمر پڑی ہے رداروی کے لیے
مگرمیں یہ اشارہ غیبی نہ سمجھ سکا کہ چند روز بعد کبھی نہ واپس ہونے والے سفر سے ان کا ریزرویشن ہوچکا ہے اور اپنی دھن میں روانہ ہوگیا، مجھے کیا خبر تھی کہ ع انیس دم کا بھروسہ نہیں ٹھہر جاؤ۔ اور بس عالم ناسوت میں یہ ان سے آخری ملاقات ہے، اس کے بعد ان کا روئے روشن اور رخِ زیبا دیکھنا نصیب نہ ہوگا، اور صرف حسرت ہی حسرت رہ جائے گی۔
حیف در چشم...

Social Media Policies of Medical Colleges of Pakistan

Introduction: A total of 144 medical colleges are contributing to the country’s progress. Excessive usage of social media is a cause of not only the deterioration of physical and psychological health of medical students, but has also become a defining reason of procrastination and attaining less than ideal grades. Where most western institutes implement strict social media policies in medical schools, those in Pakistan are gravely lacking. Objective: The objective of this research implementation of social media in medical schools of Pakistan and then identify the need to develop such policies. Methods: We conducted qualitative research in which method of data collection was primarily focus group discussions (FGD) of a total of 40 participants from five different medical colleges of Pakistan. The participants included medical practitioners and medical students(n=20) who were further divided into four groups of five participants each. FGD was conducted online. Results: Content analysis revealed seven core themes as point of discussions to be highlighted. Almost all participants were grossly unaware of the importance of social media usage regulation and its implementation in medical schools. Conclusion: At the end of the FGD it was unanimously agreed upon that there must be a uniform and standard social media policy defined by the regulating bodies of medical schools. This research may further be conducted by including policymakers in the sample. KEYWORDS: Social media, policy, medical colleges.

Region Growing Approach for Segmentation of Brain Mri Images

This thesis aims to understand low level segmentation and quantification aspects of brain MR slices purely from imaging perspective. In this context we propose two fully automatic and novel preprocessing techniques for improvement in low level segmentation. At first place we propose a novel method for cerebrum localization which reduces extraneous information from brain MR slices significantly. Up to our best knowledge no one used this cerebrum extraction approach before. Secondly a novel polygonal seed selection procedure is suggested and preferred over histogram peaks method in the absence of prior to improve initial conditions for region growing. In addition to this we present a generalized conceptual framework for region growing segmentation designed through exhaustive region growing literature review. Extensive qualitative results have been shown over full brain MR volume for segmentation. The quantification aspect is also attempted to compare segmentation results with available ground truth. Ten T1-Weighted (voxel size: 1 mm3; dimensions: 181 x 217 x 181) Normal brain phantom datasets with varying noise and inhomogeneity along-with true anatomical model have been downloaded from McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University and are subject to low level segmentation using Otsu’s method, Seeded Region Growing Method (SRG), Watershed Transformation and K-Means Clustering. The preprocessing strategies with respect to brain MR images include intensity normalization, local histogram smoothing, non-local mean (NLM) filtering and cerebrum localization. To demonstrate cerebrum extraction over full brain MR volume the Otsu’s method along with hill down optimization is used which neatly separates the four tissue classes in brain MR slices, namely Background (BG), Cerebrospinal fluid (CSF), Gray Matter (GM) and White matter (WM). This initial Otsu’s segmentation along with novel polygonal seed selection scheme puts global information into service to improve initial conditions for seeded region growing (SRG). The polygonal seeds idea is also experimented with watershed segmentation and K-Means clustering of brain MR images showing clear improvement in initial conditions but more work needs to be done with geometrical foreground markers and seeds. Confusion matrix analysis shows that Otsu’s algorithm fails to segment CSF pixels especially when noise level is increased. In comparison to Otsu’s segmentation region growing always identify CSF pixels with an accuracy of around 30% to 50% over entire brain MR volume. Otsu’s method identifies GM and WM pixels most of the time with an accuracy of 88% to 99% percent while region growing capacity to classify these pixels ranges from 60% and 90% respectively. Normalized Root Mean Square Error (NRMSE) for CSF, GM and WM volume densities of ten subjects comes out 1.1%, 3.3% and 3.3% respectively from Otsu’s Segmentation while it is 3.8%, 6.2% and 5.1 % from region growing results for single subject. In terms of volume density these normal brain phantom data sets contain highest GM density, then WM density and least volume is occupied by CSF voxels.