scholarly journals Trends of Gestational Trophoblastic Disease at a Tertiary Care Hospital

2018 ◽  
Vol 12 (1) ◽  
pp. 26-31
Author(s):  
Beemba Shakya ◽  
Gehanath Baral
Keyword(s):  
High Risk ◽  
Vaginal Bleeding ◽  
Actinomycin D ◽  
Tertiary Care ◽  
Low Risk ◽  
Risk Scores ◽  
Care Hospital ◽  
Common Presentation ◽  
Invasive Mole

Aims: The objective of this study was to determine the clinical presentation of GTD and response of GTN to single and multiple agent chemotherapy on the basis of WHO Prognostic risk scoring system.Methods: This was a cross-sectional retrospective study undertaken at Paropakar Maternity and Women’s Hospital. The medical records of 102 GTD cases were reviewed from January 25, 2015 to January 24, 2016. Data pertaining patient characteristics, histopathology types of GTD, management, prognostic risk scores, chemotherapy, follow up and remissions were retrieved and were analyzed using SPSS version 16.0.Results: Among 102 GTD cases, the most common presentation was vaginal bleeding 69(67.6%) followed by ultrasound diagnosed cases 30(29.4%). Primary management of all cases were suction evacuation, 68 completed and 12 are under follow-up. GTN was diagnosed in 14/90 (15.5%) of complete mole and 5/90 (5.5%) of partial mole. Twenty-two cases received chemotherapy for persistent gestational trophoblastic tumour(19) and invasive mole(3). Twenty cases were low risk score group and two cases under high risk group. Out of 20 low risk cases that received MTX-FA, 13/20 (65%) achieved remission. Due to low response of MTX-FA, five of them were converted to Actinomycin-D and achieved remission (100%). Two high risk cases received EMA-CO regimen and achieved 100% remission. Two low risk GTN, complete and invasive mole (underwent hysterectomy) are undergoing MTX-FA chemotherapy.Conclusions: The most common presentation of GTD was vaginal bleeding. Low risk GTN achieved 65% remission with Methotrexate-Folinic acid, ultimately achieved 100% remission with Actinomycin-D. High risk GTN achieved 100% remission with EMA-CO regimen.

scholarly journals MORPHOLOGIC SPECTRUM AND CLINICO-PATHOLOGICAL CORRELATION OF GASTROINTESTINAL STROMAL TUMOURS: AN EXPERIENCE OF SIX YEARS AT A TERTIARY CARE HOSPITAL.

2016 ◽  
Vol 2 (4) ◽  
Author(s):  
Asim Qureshi ◽  
Hina Tariq ◽  
Zafar Ali ◽  
Nadira Mamoon ◽  
Imran N Ahmed ◽  
...  
Keyword(s):  
Small Intestine ◽  
High Risk ◽  
Tertiary Care ◽  
Gastrointestinal Stromal Tumour ◽  
Low Risk ◽  
Stromal Tumour ◽  
Risk Category ◽  
Care Hospital ◽  
Risk Categorisation

Objective: The objective of this study was to determine the morphologic spectrum and risk category of gastrointestinal stromal tumour (GIST) and compare with overall patient survival.Materials and Methods: It is a descriptive observational study. The study was carried at Shifa International Hospital, Islamabad. Duration of the study was from January 2009 to January 2015. A total of 31 patients with the diagnosis of GIST were included, irrespective of age and gender. Data were retrieved from laboratory information system. Results were analysed by statistical software, Statistical Package of the Social Sciences. Morphologic type, site of tumour, risk category and overall survival were determined and mean, standard deviation, frequencies and percentages were calculated for age site and risk category. Results: Of 31 patients, 21 (67.7%) were male and 10 (32.3%) were female. Site of tumour was as follows: Gastric 13 (41.9%), extra visceral 6 (19.4%), small intestine 9 (29.0%), rectum 2 (6.5%) and pancreas 1 (3.2%). According to risk categorisation, one was categorised as (3.2%) very low risk, 3 (9.7%) low risk, 5 (16.1%) intermediate risk and 22 (71%) high risk. Follow-up was available in 21 patients. 7 patients (22.5%) lost to follow-up. 8 (25%) had recurrence and 4 (12.9%) died. Conclusion: Majority of cases diagnosed at our centre were gastric in origin followed by small intestine, and as per risk categorisation, most were high risk. Patient survival with high-risk tumours was dismal. Key words: Gastrointestinal stromal tumour, immunohistochemistry, risk categorisation 

Gestational trophoblastic disease: Experience at a tertiary care center from a developing country

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16041-16041
Author(s):  
R. Hariprasad ◽  
K. Ganessan ◽  
A. Gupta ◽  
L. Kumar ◽  
S. Kumar ◽  
...  
Keyword(s):  
High Risk ◽  
Actinomycin D ◽  
Care Center ◽  
Tertiary Care ◽  
Risk Groups ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
Molar Pregnancy ◽  
Excellent Outcome ◽  
Trophoblastic Disease

16041 Background: We retrospectively analyzed case records of patients diagnosed to have Gestational Trophoblastic Disease (GTD) to determine clinical characteristics, risk groups, treatment outcome, and reproductive function post treatment. Methods: Between Jan 1991 to Dec 2005, 102 patients (mean age: 28.2 years, range 19–50) were diagnosed to have GTD. 35 patients were nulliparous and 8 had prior molar pregnancy. Vaginal bleeding was the most common presenting symptom (77.5%). The antecedent pregnancy was vesicular mole in 50%, abortion - 34.3%, ectopic pregnancy - 4% and term pregnancy in 11.8% patients. The mean value of B hCG was 1225386 mIU/ml. The histopathology (n=85) was complete mole in 30, partial mole - 28, invasive mole- 9, PSTT -1 and choriocarcinoma in 17 patients. 68(66.7%) patients had non-metastatic disease. Sites of metastasis were - lung (38.2%), vagina (11%), brain (8.8%), liver (6.9%) and kidney, Urinary bladder and peritoneum in one patient each. According to modified WHO risk scoring - 78(76.5% had low risk and 24 (23.5%) were high risk. Results: Eighty-seven (85.3%) patients received chemotherapy using methotrexate with leucovorin (n=63), EMA/CO (n=19) and BEP (n=5). 77/87 (89.5%) achieved complete remission (CR) ; the response rate was higher in non-metastatic GTD (p<0.05). Two of 7(28.6%) patients with liver and 5/9 (55,6%) of brain metastasis achieved CR. Two patients had grade III oral mucositis and diarrhoea with methotrexate. One patient died of Methotrexate hypersensitivity. 19 patients received second line chemotherapy using EMA/CO (n=11), EMA/EP (n=2), BEP (n=1), actinomycin-D (n=1) and MAC (methotrexate, actinomycin D and Cyclophosphamide) n=1; 14 patients achieved CR. At a mean follow up of 180 months, 5-year survival for patients with low risk is 100% and that of high risk is 95%. Eight patients had recurrent disease including recurrent molar pregnancy in four. 16 patients had 24 successful deliveries after completion of treatment and 10 of them were primiparae. No fetal abnormalities were found. We did not observe second malignancy or other therapy related sequele. Conclusions: Present study confirms excellent outcome for patients with gestational trophoblastic disease. The potential for childbearing is well maintained. No significant financial relationships to disclose.

scholarly journals Impact of frailty status on medium-term follow up in patients undergoing percutaneous transcatheter aortic valve implantation in a high-flow referral center with high procedural volumes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Fumagalli ◽  
A Blandina ◽  
G Nardi ◽  
S Campicelli ◽  
G Bandini ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Tertiary Care ◽  
Composite Endpoint ◽  
Low Risk ◽  
Medium Term ◽  
Frailty Status ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

Abstract Background Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Current guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients. Purpose To assess the impact of frailty status on a composite endpoint comprising mortality and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care center. Methods Consecutive patients &gt;80 years referred to TAVI from January to December 2019 at our tertiary care institution were prospectively screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the Multidimensional Prognostic Index (MPI). Physical function was evaluated by the Short Physical Performance Battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB &lt;6 is an established strong predictor of mortality and disability. The MPI is a three-level score used to stratify risk of mortality (low, intermediate or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy and co-habitation). Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up. Results Overall, 134 patients were referred for TAVI (mean age: 84±4 years; &gt;90 years: 12%, women 67%). The average STS risk score was 4.6±3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3±3.7 (SPPB &lt;6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R=0.31, p=0.01, MPI R=0.29, p=0.03, Figure Panel A and B). At 12 months, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N=6 (4.5%); stroke: N=4 (3.0%); re-do: N=1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs low risk: HR 2.9, 95% CI 1.1–6.8, p=0.031, Figure 1 Panel C), while no association with STS (p=0.332) was found. Conclusions In a prospectively enrolled cohort of TAVI candidates, frailty indices stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Role of Uterine Artery Doppler to Predict Pregnancy Induced Hypertension and Intrauterine Growth Restriction

2021 ◽  
Vol 8 (01) ◽  
pp. 5192-5195
Author(s):  
Pallavi Gurav ◽  
Dr.Mangala Rajput
Keyword(s):  
High Risk ◽  
Pulsatility Index ◽  
Uterine Artery ◽  
Risk Group ◽  
Tertiary Care ◽  
High Risk Group ◽  
Low Risk ◽  
Care Hospital ◽  
Early Screening ◽  
Uterine Artery Doppler

Introduction: Early screening for preeclampsia and IUGR using Doppler ultrasound may allow vigilant antenatal surveillance, early diagnosis, proper treatment, and appropriate timing of fetal delivery in order to avoid serious sequelae. The present study was to evaluate the predictive value, sensitivity, and specificity of uterine artery Doppler at18-20 weeks of gestation with regards to the development of preeclampsia using pulsatility index as a parameter. Methods: A total of 100 females between 18-20 wks of gestation were included in the present Prospective observational study was carried out in Obstetrics and Gynecology department at tertiary care hospital from June 2010 to June 2012. Results: In the low-risk group, an early diastolic notch was present in 5(10%) females, out of these 3(60%) developed PIH, and 4(80%) developed IUGR.  The pulsatility index was abnormal in 8(16%) women. Out of these 5(62.5%) developed PIH and 3(37.5%) developed IUGR. In the high-risk group, an early diastolic notch was present in 8(16%) females, out of these 7(87.5%) developed PIH, and 6(75%) developed IUGR. The pulsatility index was abnormal in 9(18%) women, where 6(66.6%) developed PIH and 8(88.88%) developed IUGR. Conclusion: Abnormal uterine artery Doppler at 24 weeks of gestation was a statistically significant predictor of PIH in both low-risk and high-risk groups.  Key Words: Doppler, Pre-eclampsia, Pulsatility index, IUGR

scholarly journals Incidence, Management, and Outcome of Molar Pregnancies at a Tertiary Care Hospital in Quetta, Pakistan

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Mahrukh Fatima ◽  
Pashtoon Murtaza Kasi ◽  
Shahnaz Naseer Baloch ◽  
Masoom Kassi ◽  
Shah Muhammad Marri ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Single Agent ◽  
Care Hospital ◽  
Trophoblastic Diseases ◽  
Significant Burden ◽  
Gestational Trophoblastic Diseases ◽  
Risk Patients ◽  
Invasive Mole ◽  
Almost All

Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. The incidence appears to be higher in women from South Asia. The purpose of our prospective study was to determine the incidence, presentation, and outcomes of all molar pregnancies at our institution. During the study period, there were a total of 16,625 patients admitted to our department; out of whom 85 patients were diagnosed with a molar pregnancy. Vaginal bleeding was the commonest symptom (94.2%); theca lutein cysts were noted in 39% of the cases. Suction, dilatation, and curettage were noted to be the preferred method in almost all cases; hysterectomy was done in 12 (14.1%) patients. Single-agent chemotherapy was employed in high-risk patients and was well tolerated. Mean followup for these patients was 5.7 months (range 1–24 months). None of these patients developed persistent trophoblastic disease, invasive mole, or choriocarcinoma during the follow-up period.

scholarly journals Outcome Of Immediate PPIUCD At Follow Up Visit In Women At A Tertiary Care Hospital In Karachi, Pakistan

2018 ◽  
Vol 09 (01) ◽  
pp. 43-47
Author(s):  
Sadia Suboohi ◽  
Sughra Abbasi ◽  
Saba Pario
Keyword(s):  
General Hospital ◽  
Vaginal Bleeding ◽  
Vaginal Discharge ◽  
Post Partum ◽  
Tertiary Care ◽  
Reproductive Age ◽  
Contraceptive Device ◽  
Care Hospital ◽  
Abnormal Vaginal Discharge

Objective: To evaluate the outcome of Immediate Post Partum Intrauterine Contraceptive device (PPIUCD) insertion among married women of reproductive age at a tertiary care Creek General Hospital, Karachi, Pakistan. Study Design: Prospective Interventional study. Methodology: The clinical study was conducted in department of Obstetrics & Gynaecology, Creek General hospital Karachi from August 2015 to July 2016. One hundred and twenty five women were selected for immediate PPIUCD insertion, however the result was analysed for hundred women as twenty five were lost to follow-up. PPIUCD was inserted within 10 minutes of delivery of placenta. Follow up was done at 6 weeks, the primary outcome measures were the clinical outcomes in terms of safety (irregular vaginal bleeding, abnormal vaginal discharge, infection and perforation) and efficacy (un-descended IUCD strings, expulsion, discontinuation and pregnancy). The results were analyzed by SPSS data analysis software (IOBM). Results: Among hundred women in whom PPIUCD was inserted and returned for follow-up, majority (44%) were in age group 26-30 years; around 52% had primary or less education, and considerably high (84%) belonged to the low socio economic status. Moreover, majority (46 %) had 3 or more alive children. Importantly, 73% women had IUCD inserted after vaginal delivery. As safety was evaluated, irregular vaginal bleeding was observed in 15%, abnormal vaginal discharge (20%), infection (11%), abdominal pain (4%) and perforation in only 1% of cases. Finally, in terms of efficacy the undescended IUCD strings were observed in 7%, expulsion incidence (6%), discontinuation requested by (5%) and none of the case ended up in pregnancy. Conclusion: Post partum IUCD insertion immediately following delivery is an effective, safe, and acceptable long-term reversible method available for postpartum contraception.

Abstract 12818: Identifying Drivers of Hospital Readmission Through Analysis of Discrepant Predicted and Observed Readmission Status

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Allison Kratka ◽  
Jodi Dalto ◽  
Jennifer Beloff ◽  
Hojjat Salmasian ◽  
Kathryn Britton
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Chart Review ◽  
Clinical Care ◽  
Hospital Readmissions ◽  
Low Risk ◽  
Care Plan ◽  
Risk Scores ◽  
Negative Score

Introduction: The Hospital Readmissions Reduction Program (HRRP) lowers Medicare payments to hospitals with excess readmissions for certain conditions. We analyzed FY2020 HRRP data for Brigham and Women’s Hospital (July 2015 to June 2018). We conducted an analysis to identify patients with a discrepant expected vs observed readmission status for AMI, HF and CABG, followed by a chart review to explain this discrepancy. Methods: We calculated the risk of readmission for each patient, which was a summed value of the weights associated with all recorded comorbidities in the CMS data. A negative risk score indicated a patient was unlikely to be readmitted and a positive score indicated the opposite. We then performed a chart review focused on patients who had a high risk of readmission but were not readmitted, and those who had a low risk of readmission but were readmitted. Results: For AMI, 18% (108/596) of patients were readmitted within 30 days, CABG 14% (50/357) of patients, and HF 27% (367/1382) of patients. For AMI, risk of readmission scores ranged from 2.75 to -0.095. 5/596 patients had a negative score, and none were readmitted. For CABG, scores ranged from 2.64 to -0.31, 58/357 people had a negative score, and 6 were readmitted. For HF, scores ranged from 1.94 to 0.055. There were no negative scores, but of the lowest 20/1382 scores, 2 were readmitted. We then performed a chart review of 37 patients whose readmission status was discordant with their risk score, and examined why this occurred. For patients who were low risk but were readmitted across all three conditions, 30% (range 10% - 54%) did not have a follow up appointment scheduled before discharge, 11% (range 0% - 29%) did not have an advanced care plan and 95% (range 86% - 100%) had not had a SIC. Patients who were high risk but not readmitted were evaluated but did not have any notable characteristics. We did not find any evidence of under-coding of risk comorbidities that would have led to falsely low risk scores. Conclusions: Patients with more comorbidities were more likely to get readmitted, and we found these risk factors to be accurately recorded. Clinical care insights from this project include the need for more SICs and palliative care consults and a more targeted effort to ensure patients have appropriate follow-up.

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