scholarly journals Outbreak response management of a COVID-19 patient diagnosed on an open ward in Singapore

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Surinder Kaur Pada
Keyword(s):  
Built Environment ◽  
Hand Hygiene ◽  
Risk Stratification ◽  
Natural Ventilation ◽  
General Ward ◽  
Low Risk ◽  
Newly Diagnosed ◽  
Outbreak Response ◽  
Open Ward

We describe events leading to and actions taken to address a newly diagnosed COVID-19 case, admitted as dengue on the general ward. A risk Stratification strategy of patients into high, medium and low risk was considered for the isolation and COVID-19 swabbing strategies. Additional measures for cleaning and ward lockdown were also employed. There were a total of 191 exposures; 68 staff, 39 inpatients and the rest were community contacts. There was no transmission of COVID-19 in the 14 days following exposure, suggesting that a universal surgical mask and hand hygiene strategy in place at that time was sufficient in preventing transmission. The built environment of adequate bed-space and natural ventilation were other important considerations.

scholarly journals Risk Stratification Integrating Deauville Score on Interim PET-CT Scan and Baseline International Prognostic Index in Diffuse Large B-Cell Lymphoma Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1698-1698
Author(s):  
Ho-Young Yhim ◽  
Sung Kyun Yim ◽  
So Yeon Jeon ◽  
Yeon-Hee Han ◽  
Myung-Hee Sohn ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Ct Scan ◽  
Treatment Outcomes ◽  
B Cell Lymphoma ◽  
Low Risk ◽  
Ct Scans ◽  
Newly Diagnosed ◽  
Interim Pet ◽  
Pet Ct ◽  
Pet Ct Scan

Abstract Background Interim 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scan may predict outcomes in patients with diffuse large B-cell lymphoma (DLBCL). However, overall accuracy in predicting treatment outcomes on adopting 5-point Deauville score (DS) was considerably low in DLBCL because of mainly low positive predictive value of interim PET-CT scans. This suggested that additional tool might be needed to more accurately predict treatment outcomes. International prognostic index (IPI) was greatly associated with outcomes for DLBCL and considered to reflect biologic aggressiveness of DLBCL. Thus, we hypothesized that combined assessments using DS on interim PET-CT scan and baseline IPI might improve the prediction of treatment outcomes in DLBCL patients. In this study, we aimed to establish the risk predicting model integrating DS on interim PET-CT as an estimate of early metabolic response and baseline IPI as a predictor of biologic aggressiveness in patients with newly diagnosed DLBCL. Methods In this retrospective cohort study, we consecutively enrolled patients with newly diagnosed DLBCL. Patients were eligible if they were histologically confirmed with DLBCL from Jan 2007 to June 2016, received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), and had PET-CT scan data at baseline and at interim after 3 cycles of R-CHOP. Primary CNS or transformed DLBCLs were excluded. Interim PET-CT was assessed using 5-point DS and four point or higher was regarded as positive. All PET-CT scans were assessed by 2 experienced nuclear medicine physicians, who were masked to treatment outcomes of the patients. Discrepant interpretations between 2 nuclear medicine physicians were resolved by consensus through mutual discussion. Results A total of 316 patients were screened for eligibility. Ninety-six patients were excluded from the analysis due to following reasons: unavailable baseline (n=9) or interim PET-CT scans (n=48), early death before interim PET-CT (n=16), Primary CNS or transformed DLBCLs (n=15), and insufficient medical records (n=8). Thus, 220 patients were analyzed. Median age was 64 years (range, 19-87) and 132 (60%) were male. Based on the IPI risk, patients were classified as the low or low-intermediate (LI; N=126, 57%), and high-intermediate (HI) or high (N=94, 43%) groups. Interim DS was determined as 1 (n=67, 30.5%), 2 (n=65, 29.5%), 3 (n=39, 17.7%), 4 (n=36, 16.4%), and 5 (n=13, 5.9%). With a median follow-up of 56.6 months (IQR 36.0-71.8), 5-year progression-free survival (PFS) rate was 65.2% (95% CI, 58.1-72.3) and overall survival (OS) rate was 69.9% (95% CI, 63.2-76.6). Interim DS (1-3 vs 4-5) and the IPI (low-LI vs HI-high) were independently associated with PFS (for interim DS of 4-5, hazard ratio [HR], 2.96 [95% CI, 1.83-4.78], P < 0.001; for HI-high IPI, HR, 4.84 [2.84-8.24], P < 0.001) and OS (for interim DS of 4-5, HR, 2.98 [1.79-4.98], P < 0.001; for HI-high IPI, HR, 5.75 [3.14-10.51], P < 0.001) in the multivariate analysis. We stratified patients into 3 groups based on the risk of progression: Low (low-LI IPI and interim DS 1-3), Intermediate (low-LI IPI with interim DS 4-5, or HI-high IPI with interim DS 1-3), and High (HI-high IPI and interim DS 4-5) risk groups. The risk stratification model showed a significant association with PFS (for low risk vs intermediate risk, HR 3.98 [95% CI, 2.10-7.54], P<0.001; for low risk vs high risk, HR 13.97 [7.02-27.83], P<0.001; Fig 1A) and OS (for low risk vs intermediate risk, HR 4.14 [2.01-8.54], P<0.001; for low risk vs high risk, HR 16.05 [7.59-33.94], P<0.001; Fig 1B). Conclusion Combining interim DS with baseline IPI can improve risk stratification in patients with newly diagnosed DLBCL. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

Improving risk stratification among veterans with newly diagnosed, clinically low-risk prostate cancer using the 17-gene genomic prostate score assay.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e16611-e16611
Author(s):  
Julie Ann Lynch ◽  
Megan Rothney ◽  
Raoul Salup ◽  
Cesar Emilio Ercole ◽  
Sharad Mathur ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Stratification ◽  
Low Risk ◽  
Newly Diagnosed ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Molecular Indicators of High-Risk Disease.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. sci-6-sci-6
Author(s):  
John D. Shaughnessy ◽  
Bart Barlogie
Keyword(s):  
Gene Expression ◽  
Cell Proliferation ◽  
High Risk ◽  
Risk Stratification ◽  
Staging System ◽  
Low Risk ◽  
Proliferation Index ◽  
Newly Diagnosed ◽  
Gene Model ◽  
Staging Systems

Abstract High-risk multiple myeloma (HRMM) is routinely defined by laboratory parameters alone or in combination in the Durie-Salmon and, more recently, the ISS staging systems. The Bartl grade, a cell morphology-based staging system, has seen limited use. The presence of abnormal cytogenetics, high BrdU labeling index, interphase FISH abnormalities, and flow cytometric measures have also been used. A molecular-based classification and risk stratification of MM may improve the definition of HRMM. Global gene expression profiling (GEP) with of CD138-selected plasma cells followed by unsupervised hierarchical cluster analysis revealed that MM comprises a spectrum of seven distinct reproducible subtypes. A validated molecular classification schema has been defined as follows: (MS = t(4;14); MF = t(14;16) or t(14;20); CD-1 = t(11;14) or t(6;14) and CD-2 = t(11;14) or t(6;14) with high CD20 and/or VPREB3), hyperdiploidy (HY = high DKK1, FRZB, NCAM1, TNFSF10), low bone disease (LB = NF-kB signature, high CCND2, CST6, and IL6R) and proliferation (PR = high MIK67, CCNB1, CCNB2, TOP2A, and TYMS). Correlating GEP with outcome in two independent cohorts permitted the identification of a high-risk signature (UAMS 17-gene model), present in approximately 13% of newly diagnosed disease. GEP and high-resolution comparative genomic hybridization in 92 cases confirmed that the altered expression of the 17 genes in the model is driven by 1q gains and 1p losses. This high-risk signature is evident in a subset of all 7 molecular subtypes and negatively influences outcome. For example, low-risk MS disease fares much better than high-risk MS disease. We recently reported that the addition of bortezomib to TT3 has significantly improved outcome in low-risk MS disease, thereby demonstrating the value of GEP in evaluating benefits of new treatments that might be otherwise masked. When subjected to multivariate analysis including the International Staging System (ISS) and a gene expression-based proliferation index (GEP PI), the UAMS 17-gene model remained a significant predictor of outcome. Mulligan and colleagues developed outcome classifiers for relapsed disease treated with single agent bortezomib or high dose dexamethasone improved upon the risk stratification provided by the ISS. These predictive models showed some specificity for bortezomib. Using U133A data from newly diagnosed disease treated with ASCT, the Mayo clinic group validated the UAMS 17-gene model, but also showed that the t(4;14) translocation remained a significant adverse variable. The IFM recently reported on a 15-gene model of high-risk (IFM 15-gene model) related to cell proliferation. Multivariate showed that the UAMS 17-gene model was significant in all datasets, while the IFM 15-model was significant in a limited number. This difference might be attributed to the dependence of the IFM model to cell proliferation. GEP on 71 paired diagnostic and relapse samples indicate that the UAMS 17-gene model score increases in 80% of the cases and a low-risk to high-risk conversion in 14 of 24 (58%) severely impacted post-relapse survival. Expression of TP53 is a surrogate for 17p13 deletion, and TP53 expression below a specific threshold (seen in approximately 10% of newly diagnosed disease) imparts a poor prognosis in low-risk – but not high-risk – MM, defined by the UAMS 17-gene model. In conclusion, while the majority of patients with MM can anticipate long-term disease control, approximately 25% of patients with molecularly defined HRMM do not benefit from current approaches.

scholarly journals MPC-08 Molecular risk stratification using genome-wide DNA methylation data of standard-risk medulloblastomas treated with 18-Gy craniospinal irradiation

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii12-ii12
Author(s):  
Tomoya Irikura ◽  
Kohei Fukuoka ◽  
Makiko Mori ◽  
Koichi Oshima ◽  
Yuki Arakawa ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Disease Onset ◽  
Low Risk ◽  
Craniospinal Irradiation ◽  
Diagnostic Tools ◽  
Late Relapse ◽  
Mycn Amplification ◽  
Group 4 ◽  
Radiation Induced ◽  
Standard Risk

Abstract A novel risk stratification of medulloblastoma has been proposed based on retrospective data from patients undergoing standard treatment. However, it remains unclear whether the classification is applicable to patients receiving reduced-dose craniospinal irradiation (CSI). We performed molecular diagnosis and copy number analysis using methylation array on patients with standard-risk medulloblastoma treated with 18 Gy CSI at our institution. Nine tumor samples were available for analysis from seven patients who had a median age of 7.4 years at disease onset and a median observation period of 73 months. Three patients had recurrence, and another patient developed radiation-induced glioblastoma. From the three recurrent cases, one was molecularly diagnosed as SHH subtype with MYCN amplification; another case was a Group 4 tumor without favorable prognostic chromosomal aberrations, and the remaining patient experienced a very late relapse despite low-risk stratification. Of the recurrence-free cases, one was classified as WNT subtype, and another was a Group 4 tumor with chromosome 7 gain, and loss of chromosomes 8 and 11, both of which were associated with good prognosis. Methylation analysis also unveiled the fact that the recurrent tumor diagnosed as relapsing medulloblastoma by conventional diagnostic tools was in fact a radiation-induced glioblastoma. Our data suggested that the new risk stratification may be useful for cases treated with CSI reduced to 18 Gy. However, due to the presence of the late-relapsed case stratified to low risk, further investigations with a larger cohort should be required to confirm the data.

Identification of Molecular Biomarkers and Pathways for Risk Stratification in Human Papilloma Virus-Associated Cancers

2021 ◽  
Author(s):  
Eun Jung Kwon ◽  
Hye Ran Lee ◽  
Ju Ho Lee ◽  
Mihyang Ha ◽  
Yun Hak Kim ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Expression Patterns ◽  
Risk Groups ◽  
Molecular Biomarkers ◽  
Low Risk ◽  
Receptor Interaction ◽  
Prognostic Impact ◽  
Tumor Microenvironments ◽  
Cell Immunity

Abstract Background: Human papillomavirus (HPV) is the major cause of cervical cancer (CC) etiology; its contribution to head and neck cancer (HNC) incidence is steadily increasing. As individual patients’ response to the treatment of HPV-associated cancer is variable, there is a pressing need for the identification of biomarkers for risk stratification that can help determine the intensity of treatment. Methods: We have previously reported a novel prognostic and predictive indicator (HPPI) scoring system in HPV-associated cancers regardless of the anatomical locations by analyzing the TCGA and GEO databases. In this study, we comprehensively investigated the association of group-specific expression patterns of common differentially expressed genes (DEGs) between high-risk and low-risk groups in HPV-associated CC and HNC, identifying a molecular biomarkers and pathways for the risk stratification. Results: Among the identified 174 DEGs, expression of the genes associated with extracellular matrix (ECM)-receptor interaction pathway (ITGA5, ITGB1, LAMB1, LAMC1) were increased in high-risk groups in both HPV-associated CC and HNC while expression of the genes associated with the T-cell immunity (CD3D, CD3E, CD8B, LCK, and ZAP70) were decreased vise versa. The individual genes showed statistically significant prognostic impact on HPV-associated cancers but not on HPV-negative cancers. The expression levels of identified genes were similar between HPV-negative and HPV-associated high-risk groups with distinct expression patterns only in HPV-associated low-risk groups. Each group of genes showed negative correlations, and distinct patterns of immune cell infiltration in tumor microenvironments. Conclusion: These results identify molecular biomarkers and pathways for risk stratification in HPV-associated cancers regardless of anatomical locations. The identified targets are selectively working in only HPV-associated cancers, but not in HPV-negative cancers indicating possibility of the selective targets governing HPV-infective tumor microenvironments.

scholarly journals Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 5-12 ◽  
Author(s):  
Dominique N van Dongen ◽  
Rudolf T Tolsma ◽  
Marion J Fokkert ◽  
Erik A Badings ◽  
Aize van der Sluis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
St Elevation

Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group ( p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group ( p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk ( p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.

scholarly journals Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm

2021 ◽  
Vol 11 ◽  
Author(s):  
Xuehua Xi ◽  
Ying Wang ◽  
Luying Gao ◽  
Yuxin Jiang ◽  
Zhiyong Liang ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Low Risk ◽  
Validation Dataset ◽  
Intermediate Risk ◽  
Solid Mass ◽  
Incidence And Mortality ◽  
Risk Stratification Model

BackgroundThe incidence and mortality of thyroid cancer, including thyroid nodules &gt; 4 cm, have been increasing in recent years. The current evaluation methods are based mostly on studies of patients with thyroid nodules &lt; 4 cm. The aim of the current study was to establish a risk stratification model to predict risk of malignancy in thyroid nodules &gt; 4 cm.MethodsA total of 279 thyroid nodules &gt; 4 cm in 267 patients were retrospectively analyzed. Nodules were randomly assigned to a training dataset (n = 140) and a validation dataset (n = 139). Multivariable logistic regression analysis was applied to establish a nomogram. The risk stratification of thyroid nodules &gt; 4 cm was established according to the nomogram. The diagnostic performance of the model was evaluated and compared with the American College Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), Kwak TI-RADS and 2015 ATA guidelines using the area under the receiver operating characteristic curve (AUC).ResultsThe analysis included 279 nodules (267 patients, 50.6 ± 13.2 years): 229 were benign and 50 were malignant. Multivariate regression revealed microcalcification, solid mass, ill-defined border and hypoechogenicity as independent risk factors. Based on the four factors, a risk stratified clinical model was developed for evaluating nodules &gt; 4 cm, which includes three categories: high risk (risk value = 0.8-0.9, with more than 3 factors), intermediate risk (risk value = 0.3-0.7, with 2 factors or microcalcification) and low risk (risk value = 0.1-0.2, with 1 factor except microcalcification). In the validation dataset, the malignancy rate of thyroid nodules &gt; 4 cm that were classified as high risk was 88.9%; as intermediate risk, 35.7%; and as low risk, 6.9%. The new model showed greater AUC than ACR TI-RADS (0.897 vs. 0.855, p = 0.040), but similar sensitivity (61.9% vs. 57.1%, p = 0.480) and specificity (91.5% vs. 93.2%, p = 0.680).ConclusionMicrocalcification, solid mass, ill-defined border and hypoechogenicity on ultrasound may be signs of malignancy in thyroid nodules &gt; 4 cm. A risk stratification model for nodules &gt; 4 cm may show better diagnostic performance than ACR TI-RADS, which may lead to better preoperative decision-making.

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