Microvascular reconstruction for head and neck cancers in high risk population: clinical outcomes and complications

Introduction Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. Methods This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. Results Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. Conclusions A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.

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Cisplatin +/− rucaparib after preoperative chemotherapy in patients with triple-negative or BRCA mutated breast cancer

npj Breast Cancer ◽

10.1038/s41523-021-00240-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Maitri Kalra ◽

Yan Tong ◽

David R. Jones ◽

Tom Walsh ◽

Michael A. Danso ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Neoadjuvant Therapy ◽

Triple Negative ◽

Residual Disease ◽

Disease Free Survival ◽

Parp Inhibition ◽

High Risk Population ◽

Risk Population ◽

The Impact

AbstractPatients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0–11.5 cm) with 1 (0–38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82–4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population.

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Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population

BMC Public Health ◽

10.1186/s12889-019-7958-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ausenda Machado ◽

Irina Kislaya ◽

Amparo Larrauri ◽

Carlos Matias Dias ◽

Baltazar Nunes

Keyword(s):

High Risk ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Vaccine Coverage ◽

Vaccination Strategy ◽

High Risk Population ◽

Risk Population ◽

Seasonal Influenza Vaccination ◽

Severe Influenza ◽

The Impact

Abstract Background All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. Methods The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. Results The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. Conclusion The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.

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Abstract 2143: Improved Long-Term Survival in a High Risk Population Following Drug Eluting Stent Availability

Circulation ◽

10.1161/circ.116.suppl_16.ii_464-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Maheer Gandhavadi ◽

Kendrick A Shunk ◽

Edward J McNulty

Keyword(s):

High Risk ◽

Independent Predictor ◽

Drug Eluting Stent ◽

High Risk Population ◽

Term Survival ◽

Risk Population ◽

Long Term Survival ◽

Drug Eluting ◽

The Impact

Background Data regarding the impact of drug eluting stent (DES) use on long-term outcomes outside trial populations are limited. Methods 1,547 consecutive patients underwent stent implantation from January 2000 until December 2006 at the San Francisco Veterans Affairs Medical Center. To assess the impact of DES availability on mortality, that population was partitioned into a pre-DES cohort (N=591) and a post-DES availability cohort (N=956). Kaplan-Meier survival curves for the two cohorts were compared. Results The entire population was relatively high risk: 37% had diabetes, 38% a reduced ejection fraction, and 53% a prior MI or elevated troponin prior to the procedure. Median follow up was 4.7 years for the pre-DES cohort and 1.8 years for the post-DES cohort. DES were used in 83% of procedures in the post-DES cohort. Survival improved significantly in the post-DES cohort (P = .04, Log Rank)(see Figure ). Baseline characteristics, procedural variables and discharge medications were analyzed in a Cox proportional hazards model (see Table ). DES use was an independent predictor of improved survival (Hazard Ratio for death 0.52, 95% CI .28–.95). Conclusions In an unselected, high risk population, long-term survival improved following the availability of drug eluting stents. After adjusting for potential confounding factors, DES use was an independent predictor of improved survival. Independent Predictors of Death in all 1,547 Patients

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Assessing the impact of intensive programme utilisation on HIV and sexually transmitted infection prevalence among a high-risk population in urban settings of Karnataka: evidence from three cross-sectional surveys, 2005–12

The Lancet ◽

10.1016/s0140-6736(13)61371-9 ◽

2013 ◽

Vol 381 ◽

pp. S117 ◽

Cited By ~ 1

Author(s):

Ravi Prakash ◽

Shajy Isac ◽

Parinita Bhattacharjee ◽

BM Ramesh ◽

Stephen Moses

Keyword(s):

High Risk ◽

Sexually Transmitted Infection ◽

High Risk Population ◽

Infection Prevalence ◽

Transmitted Infection ◽

Cross Sectional ◽

Risk Population ◽

Urban Settings ◽

Sexually Transmitted ◽

The Impact

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A Dispatch Screening Tool to Identify Patients at High Risk for COVID-19 in the Prehospital Setting

Western Journal of Emergency Medicine ◽

10.5811/westjem.2021.8.52563 ◽

2021 ◽

Vol 22 (6) ◽

pp. 1253-1256

Author(s):

Amy Albright ◽

Karen Gross ◽

Michael Hunter ◽

Laurel O'Connor

Keyword(s):

High Risk ◽

Negative Predictive Value ◽

Predictive Value ◽

Screening Tool ◽

Screening Tools ◽

High Risk Population ◽

Common Symptom ◽

Risk Population ◽

Positive Screen ◽

The Impact

Introduction: Emergency medical services (EMS) dispatchers have made efforts to determine whether patients are high risk for coronavirus disease 2019 (COVID-19) so that appropriate personal protective equipment (PPE) can be donned. A screening tool is valuable as the healthcare community balances protection of medical personnel and conservation of PPE. There is little existing literature on the efficacy of prehospital COVID-19 screening tools. The objective of this study was to determine the positive and negative predictive value of an emergency infectious disease surveillance tool for detecting COVID-19 patients and the impact of positive screening on PPE usage. Methods: This study was a retrospective chart review of prehospital care reports and hospital electronic health records. We abstracted records for all 911 calls to an urban EMS from March 1–July 31, 2020 that had a documented positive screen for COVID-19 and/or had a positive COVID-19 test. The dispatch screen solicited information regarding travel, sick contacts, and high-risk symptoms. We reviewed charts to determine dispatch-screening results, the outcome of patients’ COVID-19 testing, and documentation of crew fidelity to PPE guidelines. Results: The sample size was 263. The rate of positive COVID-19 tests for all-comers in the state of Massachusetts was 2.0%. The dispatch screen had a sensitivity of 74.9% (confidence interval [CI], 69.21-80.03) and a specificity of 67.7% (CI, 66.91-68.50). The positive predictive value was 4.5% (CI, 4.17-4.80), and the negative predictive value was 99.3% (CI, 99.09-99.40). The most common symptom that triggered a positive screen was shortness of breath (51.5% of calls). The most common high-risk population identified was skilled nursing facility patients (19.5%), but most positive tests did not belong to a high-risk population (58.1%). The EMS personnel were documented as wearing full PPE for the patient in 55.7% of encounters, not wearing PPE in 8.0% of encounters, and not documented in 27.9% of encounters. Conclusion: This dispatch-screening questionnaire has a high negative predictive value but moderate sensitivity and therefore should be used with some caution to guide EMS crews in their PPE usage. Clinical judgment is still essential and may supersede screening status.

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The Relationship between Metabolic Syndrome and Plasma Metals Modified by EGFR and TNF-α Gene Polymorphisms

Toxics ◽

10.3390/toxics9090225 ◽

2021 ◽

Vol 9 (9) ◽

pp. 225

Author(s):

Tzu-Hua Chen ◽

Wei-Shyang Kung ◽

Hung-Yu Sun ◽

Joh-Jong Huang ◽

Jia-Yi Lu ◽

...

Keyword(s):

Metabolic Syndrome ◽

High Risk ◽

Gene Polymorphisms ◽

Plasma Concentrations ◽

High Risk Population ◽

Physical Parameters ◽

Nucleotide Polymorphisms ◽

Risk Population ◽

Tnf Α ◽

The Impact

With the escalating global prevalence of metabolic syndrome (MetS), it is crucial to detect the high-risk population early and to prevent chronic diseases. Exposure to various metals has been indicated to promote MetS, but the findings were controversial, and the effect of genetic modification was not considered. Epidermal growth factor receptor (EGFR) was proposed to be involved in the pathway of metabolic disorders, and tumor necrotic factor-α (TNF-α) was regarded as an early inflammatory biomarker for MetS. This research aimed to analyze the impact of EGFR and TNF-α gene polymorphisms on the prevalence of MetS under environmental or occupational exposure to metals. We gathered data from 376 metal industrial workers and 639 non-metal workers, including physical parameters, biochemical data, and plasma concentrations of six metals. According to the genomic database of Taiwan Biobank, 23 single nucleotide polymorphisms (SNPs) on EGFR gene and 6 SNPs on TNF-α gene were incorporated in our research. We applied multivariable logistic regression to analyze the probability of MetS with various SNPs and metals. Our study revealed some susceptible and protective EGFR and TNF-α genotypes under excessive exposure to cobalt, zinc, selenium, and lead. Thus, we remind the high-risk population of taking measures to prevent MetS.

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