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 

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.

Impact of dose-escalated radiation on overall survival in men with nonmetastatic prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 28-28
Author(s):  
Anusha Kalbasi ◽  
Jiaqi Li ◽  
Abigail T. Berman ◽  
Samuel Swisher-McClure ◽  
Marc C. Smaldone ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Standard Dose ◽  
Low Risk ◽  
External Beam Radiation ◽  
Risk Category ◽  
Beam Radiation ◽  
Treatment Groups

28 Background: Infive publishedRCTs, dose-escalated external beam radiation therapy (EBRT) for prostate cancer resulted in improved biochemical and local control. However, the question of whether dose escalation improves overall survival (OS) remains unanswered. We examined OS among men with non-metastatic prostate cancer undergoing EBRT in the modern era. Methods: Using the National Cancer Database (NCDB), we conducted non-randomized comparative effectiveness studies of dose-escalated versus standard-dose EBRT in men diagnosed from 2004-2006 in three analytic cohorts defined by NCCN risk category: low- (N=12,848), intermediate- (N=14,966) or high-risk (N=14,587) prostate cancer. We categorized patients in each risk cohort into 2 treatment groups: standard-dose (68.4 Gy to <75.6 Gy) or dose-escalated (≥75.6 Gy to 90 Gy) EBRT. The primary outcome was time to death from any cause, measured from diagnosis to NCDB date of death or end of follow-up (December 31, 2011). We compared OS between treatment groups in the three analytic cohorts using Cox proportional hazard models. Inverse probability weighted propensity score methods were used to balance differences between treatment groups in age, race, year of diagnosis, AJCC T- and N-stage, PSA, Gleason score, androgen deprivation therapy, IMRT use, comorbid disease, income, insurance, urban/rural location, facility type and facility volume. In secondary analyses, we evaluated dose response for survival by categorizing dose in approximately 2 Gy increments. Results: Median follow up for survivors was between 73 and 74 months in all three risk cohorts. Dose-escalated EBRT was associated with improved survival in the intermediate-risk (adjusted HR 0.81, 95% CI 0.77 and 0.85, p<0.0001) and high-risk groups (aHR 0.85, 95% CI 0.81 and 0.89, p<0.0001), but not the low-risk group (aHR 0.99, 95% CI 0.92-1.06, p=0.803). For every incremental ~2Gy increase in dose, there was a 9% (95% CI 6% – 11%, p<0.0001) and 7% (95% CI 3% - 10%, p=0.004) reduction in the hazard of death for intermediate- and high-risk patients, respectively. Conclusions: Dose-escalated EBRT is associated with improved survival in men with intermediate- and high-risk, but not low-risk, prostate cancer.

scholarly journals Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients

2011 ◽  
Vol 165 (3) ◽  
pp. 441-446 ◽  
Author(s):  
Maria Grazia Castagna ◽  
Fabio Maino ◽  
Claudia Cipri ◽  
Valentina Belardini ◽  
Alexandra Theodoropoulou ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Low Risk ◽  
Risk Category ◽  
Radioiodine Ablation ◽  
Risk Patients

IntroductionAfter initial treatment, differentiated thyroid cancer (DTC) patients are stratified as low and high risk based on clinical/pathological features. Recently, a risk stratification based on additional clinical data accumulated during follow-up has been proposed.ObjectiveTo evaluate the predictive value of delayed risk stratification (DRS) obtained at the time of the first diagnostic control (8–12 months after initial treatment).MethodsWe reviewed 512 patients with DTC whose risk assessment was initially defined according to the American (ATA) and European Thyroid Association (ETA) guidelines. At the time of the first control, 8–12 months after initial treatment, patients were re-stratified according to their clinical status: DRS.ResultsUsing DRS, about 50% of ATA/ETA intermediate/high-risk patients moved to DRS low-risk category, while about 10% of ATA/ETA low-risk patients moved to DRS high-risk category. The ability of the DRS to predict the final outcome was superior to that of ATA and ETA. Positive and negative predictive values for both ATA (39.2 and 90.6% respectively) and ETA (38.4 and 91.3% respectively) were significantly lower than that observed with the DRS (72.8 and 96.3% respectively,P<0.05). The observed variance in predicting final outcome was 25.4% for ATA, 19.1% for ETA, and 62.1% for DRS.ConclusionsDelaying the risk stratification of DTC patients at a time when the response to surgery and radioiodine ablation is evident allows to better define individual risk and to better modulate the subsequent follow-up.

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 A study of risk score assessment in antenatal women and their neonatal outcome in a tertiary care hospital

2021 ◽  
Vol 8 (3) ◽  
pp. 212-219
Author(s):  
Amit Kumar ◽  
P. Sindhusha ◽  
P.J.N. Satyavathi ◽  
N. Pragnasai ◽  
P. Deepika ◽  
...  
Keyword(s):  
High Risk ◽  
Scoring System ◽  
Neonatal Outcome ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Control Group ◽  
Risk Category ◽  
Study Group ◽  
Care Hospital ◽  
Maternal Complications

A high-risk pregnancy is any condition associated with a pregnancy where there is an actual or potential risk to the mother or fetus. Risk assessment is a key component of antenatal care (ANC) and has demonstrated benefits in improving maternal and perinatal outcomes. To assess maternal complications that occurs in antenatal women and their neonatal outcomes in a tertiary care hospital.200 antenatal women, admitted to obstetrics & gynaecology department from 16-09-2020 to 15-03-2021 were evaluated. Antenatal women with maternal complications (Gestational hypertension, preeclampsia, Gestational diabetes, Hypothyroid, Anaemia, Asthma and oligohydramnios) were taken into study group and women with no complications were taken into control group. The risk factors were assessed and risk scores were determined by Dutta and Das scoring system and Hobel risk scoring system. It was found that there was a significant association between poor neonatal outcome and high-risk pregnancies. The incidence of preterm births is higher in the study group (34.1%) when compared with the control group (13.7%). Mode of delivery was predominantly by caesarean section in the study group (p&#60;0.005). Neonatal complications were significantly more (p&#60;0.05) in study group and fetal distress was exclusively seen in the study group (p&#60;0.0005). Maternal complications such as eclampsia correlated significantly with the risk score (p=0.005). Neonatal outcomes such as Low birth weight (p&#60;0.0001) were higher in the high-risk category when compared to the low risk and moderate risk category. There was a significant correlation between high-risk antenatal and poor neonatal outcome. Scoring systems, such as the one used in our study, can be adopted at primary and rural health centres even by a non-medical counsellor as a screening tool to predict pregnancies at high risk for poor neonatal outcome, thereby facilitating early referral of these women to tertiary care centres.

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

Combined overexpression of WT1 and BAALC genes May Predict AML evolution in MDS Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5204-5204
Author(s):  
Daniele Avenoso ◽  
Enrico De Astis ◽  
Nicoletta Colombo ◽  
Raffaella Grasso ◽  
Micaela Bergamaschi ◽  
...  
Keyword(s):  
Gene Expression ◽  
High Risk ◽  
Prognostic Score ◽  
Risk Groups ◽  
Disease Diagnosis ◽  
Low Risk ◽  
Risk Category ◽  
Copy Numbers ◽  
Combined Overexpression

Abstract Background and aims Myelodisplastic syndromes (MDS) are a group of hemopoietic disorder characterized by an impaired blood cell production, morphologic dysplasia and peripheral cytopenias; they are the most common hematologic neoplastic disorder and its diagnosis relays on morphologic evaluation, associated to a karyotypic assay. In order to predict the outcome of patients affected from these disorders, knowing that the order of survival can be extremely variable, several prognostic index were developed such as International Prognostic Score Sistem (IPSS) or the most usefull WHO-Prognostic Score Sistem (WPSS). On the contrary of acute leukemia, these disorders have not a biomolecular profile evalutation of intrinsic markers able to stratify patients in different prognostic risk groups. The aim of our study is to assess the risk of leukemic evolution, in MDS patients, on the basis of the levels expression of WT1 and BAALC at disease diagnosis, and to evaluate the leukemia free survival (LFS) at 6-12-24-36 months of follow up, among the different risk category according to IPSS and irrespectively of treatment. Materials and method In five years we analized 102 patients with a diagnosis of MDS divided according to the WHO classification such as follows: 38 AR, 1 AR with del(q5), 21 aREB-1, 23 AREB-2, 3 chronic myelomonocitic leukemia, 1 RARS, 1 MDS, 11 RCMD, 1 5q- syndrome, 2 suspected MDS. According to IPSS 58 belonged to the low risk category, 21 to the intermediate-1, 23 to the intermediate-2/high risk. Cytogenetic assay showed 20 people with an abnormal karyotype, 8 of them fallen into the high risk class and 12 into the intemediate risk. Low risk and intermediate-1 patients were treated only with supportive care; high risk patients were treated with hypomethylating agents. Iron chelation were used when necessary. Lenalidomide was used in the only case of 5 q- syndrome Samples of bone marrow were analized with Real-Time quantitave PCR and levels of WT1 and BAALC expression were determinated. Molecular datas were analized with X-square Test and a significant association was recorded between overexpression of the genes evaluated (WT1 higher than 100 copy numbers and BAALC higher than 1000 copy numbers) and the probability of develop acute myeloid leukemia ( AML ). Results Nine out of 102 patients showed an isolated WT1 hyperexpression (3 of them developed an AML ), in 15 cases we reported an isolated BAALC overexpression (3 of them developed an AML ), while 13 out 18 patients ( 72% ) with combined WT1 and BAALC overexpression developed AML within an average time of 6 months; instead only 5% of patients, which expressed low levels of WT1 and BAALC, developed AML within the interval of observation. In particulary a combined high expression of WT1 and BAALC were strongly associated with an high risk to develop leukemia and a short LFS, especially in INT-1 subset. After that we calculated the LFS, divided for the risk category at 6-12-24-36 months of follow up. Patients with combined overexpression of WT1 and BAALC showed a LFS of 40% at 6 months of follow up and 0% at 24 months. Conclusion MDS have a great variable survival, and the current approach to these diseases relays on morphological evaluation, karyotypic assay and need of transfusional support; gene expression could be a promising system to predict the prognosis in these patients. Analysis of gene expression, which belong to AML evaluation, allows to divide patients in several risk groups; furthermore is not the single gene evaluation that is more predictable but a combined assay. With this method, which seems to be more realiable than IPSS, we could find that a great percentage of patients with levels of WT1>100 and BAALC >1000, indipendently from karyotypic status and treatment, developed AML and have a shorter LFS than the population with WT1 <100 and BAALC < 1000. Disclosures: No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document