Influence of high-risk factors on early neurodevelopmental outcome of high-risk newborns and role of follow up compliance

This was a prospective study conducted in pregnant patients with high risk factors who got admitted in the Department of Obstetrics and Gynaecology at Care Hospital, Jamnagar during the period from May 2018 to September 2020. Background: High-risk pregnancies causes many adverse perinatal outcomes. Doppler ultrasound is a non-invasive technique to study the feto-maternal circulation to guide the clinical management. Objective: This study aims at evaluating the role of colour Doppler in high-risk pregnancies and their perinatal outcome. Materials and Methods: This was a prospective study carried out for 29 months in the Department of Radiology with antenatal women in the age group of 18-35 years with singleton pregnancy of gestational age of <28 weeks to >35 weeks having high-risk factors considered in study. The risk factors considered were pregnancy induced hypertension (PIH), gestational diabetes, anemia, oligohydramnios, polyhydramnios and IUGR. Doppler study of umbilical artery and fetal middle cerebral artery (MCA) arteries was done and amniotic fluid index (AFI) was measured. Parameters in the form of resistive index, pulsatility index, and systolic/diastolic ratio were taken. obstetric history was taken with regular interval follow up. Results: The study was carried out with 50 patients. High-risk pregnancy was more common in the age group of 21-25 years. The most common high-risk factor in pregnancy was oligohydramnios which accounted for 30% of cases. Out of 50 high-risk pregnancies, 5 (10 %) of cases resulted in intrauterine growth restriction (IUGR). Out of 50 high-risk cases, in 36 cases, umbilical artery findings were abnormal. 3 patients had intrauterine death (IUD) and 27 patients had poor perinatal outcome. Umbilical artery abnormality showed significant sensitivity and negative predictive value for adverse (poor + IUD) perinatal. Correlation was seen between high risk pregnancy and need of emergency caesarean section and induction and associated adverse perinatal outcome. Conclusion: Combination of different arterial waveform study enhance the diagnostic accuracy in identifying those intrauterine growth restricted foetuses that were at risk. Keywords: Colour Doppler, high risk pregnancy, perinatal outcome.

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Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features

Journal of Clinical Oncology ◽

10.1200/jco.2018.78.8414 ◽

2018 ◽

Vol 36 (34) ◽

pp. 3361-3369 ◽

Cited By ~ 10

Author(s):

Anna L. Godfrey ◽

Peter J. Campbell ◽

Cathy MacLean ◽

Georgina Buck ◽

Julia Cook ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Platelet Count ◽

High Risk ◽

Vascular Events ◽

End Point ◽

High Risk Factors ◽

Patient Reported

Purpose Cytoreductive therapy is beneficial in patients with essential thrombocythemia (ET) at high risk of thrombosis. However, its value in those lacking high-risk features remains unknown. This open-label, randomized trial compared hydroxycarbamide plus aspirin with aspirin alone in patients with ET age 40 to 59 years and without high-risk factors or extreme thrombocytosis. Patients and Methods Patients were age 40 to 59 years and lacked a history of ischemia, thrombosis, embolism, hemorrhage, extreme thrombocytosis (platelet count ≥ 1,500 × 109/L), hypertension, or diabetes requiring therapy. In all, 382 patients were randomly assigned 1:1 to hydroxycarbamide plus aspirin or aspirin alone. The composite primary end point was time to arterial or venous thrombosis, serious hemorrhage, or death from vascular causes. Secondary end points were time to first arterial or venous thrombosis, first serious hemorrhage, death, incidence of transformation, and patient-reported quality of life. Results After a median follow-up of 73 months and a total follow-up of 2,373 patient-years, there was no significant difference between the arms in the likelihood of patients reaching the primary end point (hazard ratio, 0.98; 95% CI, 0.42 to 2.25; P = 1.0). The incidence of significant vascular events was low, at 0.93 per 100 patient-years (95% CI, 0.61 to 1.41). There were also no differences in overall survival; in the composite end point of transformation to myelofibrosis, acute myeloid leukemia, or myelodysplasia; in adverse events; or in patient-reported quality of life. Conclusion In patients with ET age 40 to 59 years and lacking high-risk factors for thrombosis or extreme thrombocytosis, preemptive addition of hydroxycarbamide to aspirin did not reduce vascular events, myelofibrotic transformation, or leukemic transformation. Patients age 40 to 59 years without other clinical indications for treatment (such as previous thrombosis or hemorrhage) who have a platelet count < 1,500 × 109/L should not receive cytoreductive therapy.

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Locally advanced colorectal cancer: Is a second look surgery and prophylactic HIPEC warranted?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15056 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15056-e15056 ◽

Cited By ~ 1

Author(s):

Rahul Bhamre ◽

Jay Rashmi Anam ◽

Manish Bhandare ◽

Avanish Saklani

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

High Risk ◽

Advanced Colorectal Cancer ◽

Locally Advanced ◽

Peritoneal Recurrence ◽

High Risk Factors ◽

Second Look ◽

Locally Advanced Colorectal Cancer

e15056 Background: Peritoneal recurrence/carcinomatosis (PC) after curative surgery for colorectal cancer is the second most common site of recurrence and carries a poor prognosis. PC present relatively in the later stage, are difficult to detect by conventional imaging on follow up, and have limited options to treat after diagnosis. Second look surgery is the only definite option to diagnose early PC and presents an opportunity for disease control by cytoreductive surgery (CRS) and HIPEC. Multiple studies have attempted to identify clinico-pathological risk factors that predict high chances of PC. Our aim is to analyze the recurrence patterns and survival in locally advanced colorectal cancer, in an attempt to identify high risk factors for PC, which can be used as an indication for second look surgery and prophylactic HIPEC in such cases. Methods: Retrospective analysis of a prospectively maintained data of all colorectal cancer patients presenting to a tertiary cancer care referral center in India, from May 2010 to October 2015 was done. All patients who underwent surgery with curative intent and were clinico-pathological stage T4 and/or N2 M0 were included in the analysis. Results: 182 patients underwent curative resection with a clinico-pathological staging of T4 and/or N2 M0. There were 71 recurrences, out of which 30 (42.2%) were peritoneal, 7 (9.9%) were hepatic only while 34 (47.9 %) were non-hepatic systemic or multiple site. For a median follow up of 26 months, the estimated 3 year OS was 78 % while the 3 year DFS was 50.4 %. The median time to diagnosis of peritoneal recurrence was 13 months (4.7 – 55.7). The 3-year OS for patients with peritoneal recurrence was 48.6 % as against 57 % for liver only recurrence and 59.9 % for non liver systemic and multiple site recurrence, with a trend towards poorer survival for peritoneal recurrences, although non-significant (p – 0.377). Conclusions: Locally advanced colorectal cancer has a high risk of peritoneal recurrence which negatively impacts the survival. Well-designed RCTs need to be conducted to identify the high risk factors for PC and whether second look surgery and prophylactic HIPEC in such patients will improve survival with acceptable morbidity and mortality.

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Mild cases of Covid-19 in children. is it really true or a mirage?

Pediatric Review International Journal of Pediatric Research ◽

10.17511/ijpr.2020.i08.10 ◽

2020 ◽

Vol 7 (8) ◽

pp. 446-451

Author(s):

Abhishek Mandal ◽

◽

Dr. Santosh Kondekar ◽

Rishi Bothara ◽

◽

...

Keyword(s):

Risk Factors ◽

Insulin Secretion ◽

High Risk ◽

Infectious Diseases ◽

Antioxidant Potential ◽

Trained Immunity ◽

High Risk Factors ◽

Few Data

To date, very few data on pediatric COVID 19 cases have been published, and most reports originatefrom China. There is an urgent need to understand why the course of the coronavirus that started inlate 2019 is affecting different groups of individuals with varying severity during the ongoing globalpandemic. Globally, the greatest burden of most infectious diseases, especially infections of therespiratory system are borne by children, hence the low burden of COVID 19 in children has beenviewed by many as surprising. This article will provide insights regarding the role of constitutionalhigher trained immunity in children, physiological advantages of children, higher insulin secretion,higher ACE2 levels, better antioxidant potential, and absence of high-risk factors in protectingchildren against severe COVID 19 infections.

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A phase II study of a temozolomide-based chemoradiotherapy regimen for high-risk low-grade gliomas: Preliminary results of RTOG 0424.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.2008 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 2008-2008 ◽

Cited By ~ 18

Author(s):

Barbara Jean Fisher ◽

Jeff Lui ◽

David R. Macdonald ◽

Glenn Jay Lesser ◽

Stephen Coons ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Progression Free Survival ◽

P Value ◽

Low Grade ◽

Herpes Encephalitis ◽

Radiation Quality ◽

Significance Level ◽

High Risk Factors

2008 Background: The primary endpoint of RTOG 0424 was to compare the 3-year survival (OS) of a regimen of concurrent and adjuvant temozolomide (TMZ) and radiotherapy (RT) in a high-risk low-grade glioma (LGG) population to the 3 year (yr) OS rate of the high risk EORTC LGG patients (pts) reported by Pignatti et al (J Clin Oncol 2002;20(8):2076-84). Secondary endpoints were: progression-free survival (PFS), toxicity, neurocognitive and quality of life data and molecular analysis. Methods: Pts with LGG's and >=3 high risk factors (age> = 40, astrocytoma dominant histology, tumor crossing midline, tumor > = 6 cm or preoperative neurological function status >1) were eligible and treated with conformal RT (54 Gy/30 fractions) plus concurrent TMZ 75 mg/m2 /day for 6 weeks and post-RT TMZ 150-200 mg/m2/day days 1-5 q28 days for up to 12 cycles. The study was designed to detect a 43% increase in median survival time (MST) from 40.5 to 57.9 months, and a 20% improvement in 3 yr OS rate from 54% to 65%, at a 10% significance level (1 sided) and 96% power. Results: Between January 2005-August 2009 136 pts were accrued, 129 (75 males, 54 females) were evaluable. Median age was 49 years, 91% had a Zubrod score 0-1 and 69%, 25% and 6% of pts had 3,4 and 5 high risk factors respectively. With a median follow-up time of 4.1 yrs, minimum follow-up of 3 yrs, MST has not yet been reached. Three year OS rate was 73.1% (95%CI:65.3-80.8%), significantly improved from historical control with a p-value <0.0001. No difference in OS rates for pts with 3, 4 or 5 high risk factors was seen. 3 year PFS was 59.2% (95% CI:50.7-67.8%). Grade 3 adverse events (AE) occurred in 43% of pts and grade 4 AE in 10%, primarily hematologic, constitutional or gastrointestinal (nausea, anorexia) toxicity. One patient died of herpes encephalitis. Secondary analyses are ongoing. Radiation Quality Assurance was per protocol/ acceptable in 95% and 74% of pts completed chemotherapy per protocol. Conclusions: The 3 year OS rate of 73.1% for these high risk LGG pts is significantly higher than those reported for historical controls (54%, p < 0.0001, one-sided) and the study-hypothesized 65%. Supported by RTOG U10 CA21661 and CCOP U10 CA37422 grants from NCI and Merck Clinical trial information: NCT00114140.

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Prognostic role of circulating exosomal miRNAs in multiple myeloma

Blood ◽

10.1182/blood-2016-09-742296 ◽

2017 ◽

Vol 129 (17) ◽

pp. 2429-2436 ◽

Cited By ~ 92

Author(s):

Salomon Manier ◽

Chia-Jen Liu ◽

Hervé Avet-Loiseau ◽

Jihye Park ◽

Jiantao Shi ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

High Risk ◽

Survival Prediction ◽

Prognostic Role ◽

High Risk Factors ◽

Key Points ◽

Exosomal Mirnas

Key Points Two circulating exosomal microRNAs, let-7b and miR-18a, improved survival prediction in patients with MM. Circulating exosomal miRNAs enhanced the stratification of patients with high-risk factors.

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