ABSTRACT
Introduction: Well Differentiated thyroid carcinoma (WDTC) represents 80% of all thyroid malignant tumours, with good prognosis and a survival rate higher than 90% at 20 yrs. Total or subtotal thyroidectomy is the treatment of choice, with radioactive iodine (RAI) therapy reserved for adjuvant setting/ablation and/or as a curative treatment modality in patients with local recurrence and/or distant metastases. This retrospective study aimed to investigate the treatment outcome, survival rate and prognostic factors in our institution over the past half-decade. Methods: A retrospective study was conducted of 33 patients with WDTC. Data were collected from 1stJanuary 2007 to 31st December 2012 and included: Age at diagnosis, sex, histology, TNM stage, treatment received, indication for 131I therapy, doses of 131I, complication of treatment, follow-up diagnostic scan 123I / Thyroglobulin, time of recurrence since surgery and cause of death. Prognostic factors were analysed using chi-square test and crude mortality rate was used. Results: Papillary subtype is the most common type of WDTC (63.6%); mean age at diagnosis is 50 years and female to male ratio is cosmopolitan at 3.1:1 with female preponderance. RAI therapy after thyroidectomy (total or subtotal) offers complete remission in 26/33 (78.8%) and the overall mortality rate was 3/33 (9.1%) p=0.023. Conclusion: RAI therapy is safe and effective in management of patients with WDTC. The initial surgical approach is the cornerstone in the subsequent outcome of RAI therapy with very poor outcome registered in unresectable thyroid tumour and in patients with multiple organ metastases.
ABSTRACT
Aims: To characterize the various clinical presentations of TB diagnosed in HIV/AIDS patients in the post-conflict Northern Uganda. Study Design and Setting: A prospective cohort study was conducted on 320 TB/HIV/AIDS coinfected patients at St. Mary’s Hospital, Lacor which is a specialist hospital in Gulu, Northern Uganda from July 2009 to July 2010. Methodology: Clinical features of confirmed 320 HIV sero-positive patients with confirmed TB coinfection (170 males and 150 females) recruited consecutively were studied and followed up for three months, their clinical presentations analyzed using SPSS version13.0. Ethics and Review Committee approved the study and those who did not meet the inclusion criteria were excluded. All patients gave an informed consent/Assent for the study. Results: The commonest clinical presentations were fever 316(98.8%), productive cough 268(83.7%), evening/night sweats 267(83.4%), general malaise 277(86.6%), wasting 228(71.3%), anaemia 220(68.8%) and lymphadenopathy 100(31.3%). The clinical features which were associated statistically and significantly with TB/HIV/AIDS co-infection were: Low grade fever (p=0.006); haemoptysis (p=0.001); Night sweats and evening fevers (p=0.043); Chest pain (p=0.041); General malaise (p=0.037) and wasting (p=0.047). Most patients 262(81.9%) improved and were discharged on Directly Observed Therapy Short-course (DOTS) while 58(18.1%) died. Conclusion: Clinical assessment is a very important adjuvant in TB/HIV/AIDS co-epidemic diagnosis. Early diagnosis and prompt management of TB co-infection ensured longer life and reduced morbidity and mortality.