scholarly journals Clinico-pathological spectrum and novel karyotypic findings in myelodysplastic syndrome: Experience of tertiary care centre in India

2017 ◽  
Vol 9 (1) ◽  
pp. e2017048 ◽  
Author(s):  
Ruchi Gupta ◽  
Khaliqur Rahman ◽  
Khaliqur Rahman ◽  
Manish Kumar Singh ◽  
Manish Kumar Singh ◽  
...  
Keyword(s):  
High Risk ◽  
Myelodysplastic Syndrome ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Risk Groups ◽  
Limited Data ◽  
Tertiary Care Centre ◽  
Prognostic Group ◽  
Cytogenetic Profile ◽  
High Disease Burden

Background: Myelodysplastic syndrome (MDS) is a heterogeneous disorder characterized clinically by presence of cytopenia/s. Limited data is available pertaining to the morphological spectrum and cytogenetic profile of Indian MDS patients. The aim of the study was to ascertain the clinco pathological, morphological and cytogenetic spectrum of Indian MDS patients. Material and methods: A retrospective analysis of all patients diagnosed as MDS from June 2012-December 2016 was performed. Their clinical and laboratory data was collated and reviewed.Results: A total of 150 patients of as primary MDS were evaluated with M: F ratio of 1.6:1 and median age of 55.5 years. 64% patients presented with pancytopenia, with thrombocytopenia alone was seen in only 2 cases. There were 66 (44%) cases of MDS-MLD, 33 (22%) MDS-EB 2, 32 (21.3%) MDS–EB 1, 13 (8.6%) cases MDS-SLD and two cases each of MDS-SLD-RS, MDS-MLD-RS and RCC. Cytogenetic data was available in 86/150 patients, 50% of which were abnormal. Complex karyotype was observed to be the commonest abnormality (27.5%). Novel translocations like t(9;22)(q11.2;q34.2) in addition to other abnormalities (n=3), t(2;4)(p25;q23),t(1;5)(p22;q33), t(1;12)(p34;p11.2) and t(5;7;9;)(q13;q32;p22) were observed.Conclusion: The median age of patients in India is almost a decade younger than the western population. Moreover, majority of the patients belonged to the high risk IPSS-R prognostic group (31.4%), followed by intermediate (29%) and very high risk groups (24.4%) in our cohort of patients. Seventy percent individuals, < 40 years belonged to the high prognostic categories, indicating that Indian MDS patients have high disease burden and in turn more likelihood for leukemic transformation.

scholarly journals Risk Factors for Pneumonia and Death in Adult Patients With Seasonal Influenza and Establishment of Prediction Scores: A Population-Based Study

2021 ◽  
Vol 8 (3) ◽  
Author(s):  
Koichi Miyashita ◽  
Eiji Nakatani ◽  
Hironao Hozumi ◽  
Yoko Sato ◽  
Yoshiki Miyachi ◽  
...  
Keyword(s):  
High Risk ◽  
Seasonal Influenza ◽  
Prediction Models ◽  
Validation Cohort ◽  
Risk Groups ◽  
Population Based ◽  
Limited Data ◽  
Population Based Study ◽  
Relative Risks ◽  
Primary Care Settings

Abstract Background Seasonal influenza remains a global health problem; however, there are limited data on the specific relative risks for pneumonia and death among outpatients considered to be at high risk for influenza complications. This population-based study aimed to develop prediction models for determining the risk of influenza-related pneumonia and death. Methods We included patients diagnosed with laboratory-confirmed influenza between 2016 and 2017 (main cohort, n = 25 659), those diagnosed between 2015 and 2016 (validation cohort 1, n = 16 727), and those diagnosed between 2017 and 2018 (validation cohort 2, n = 34 219). Prediction scores were developed based on the incidence and independent predictors of pneumonia and death identified using multivariate analyses, and patients were categorized into low-, medium-, and high-risk groups based on total scores. Results In the main cohort, age, gender, and certain comorbidities (dementia, congestive heart failure, diabetes, and others) were independent predictors of pneumonia and death. The 28-day pneumonia incidence was 0.5%, 4.1%, and 10.8% in the low-, medium-, and high-risk groups, respectively (c-index, 0.75); the 28-day mortality was 0.05%, 0.7%, and 3.3% in the low-, medium-, and high-risk groups, respectively (c-index, 0.85). In validation cohort 1, c-indices for the models for pneumonia and death were 0.75 and 0.87, respectively. In validation cohort 2, c-indices for the models were 0.74 and 0.87, respectively. Conclusions We successfully developed and validated simple-to-use risk prediction models, which would promptly provide useful information for treatment decisions in primary care settings.

scholarly journals Profile of patients with Myelodysplastic syndrome: A report from a tertiary care teaching hospital from Eastern India

2021 ◽  
Vol 0 ◽  
pp. 1-6
Author(s):  
Ankita Sen ◽  
Arnab Chattopadhyay ◽  
Shuvra Neel Baul ◽  
Rajib De ◽  
Sumit Mitra ◽  
...  
Keyword(s):  
Myelodysplastic Syndrome ◽  
Teaching Hospital ◽  
Risk Group ◽  
Tertiary Care ◽  
Supportive Therapy ◽  
Risk Groups ◽  
Low Risk ◽  
Eastern India ◽  
Tertiary Care Teaching Hospital

Objectives: Myelodysplastic syndrome (MDS) is a group of myeloid neoplasms. The clinical manifestations and treatments vary depending on the subtype and risk stratification of the disease. There is a paucity of data on Indian patients with MDS. This study was undertaken to understand MDS with regard to their clinical presentation, pathological, cytogenetic profiles and also to assess their therapeutic outcomes and prognosis from our center in Eastern India. Material and Methods: This is a prospective observational study conducted in the department of hematology at a tertiary care teaching hospital from eastern part of India. The diagnosis of MDS was made from the peripheral blood examination, bone marrow aspirate examination, cytogenetics, and Fluorescence in situ hybridization results, according to the WHO guidelines. Patients were risk stratified using Revised International Prognostic Scoring System (R-IPSS) and subsequent therapeutic planning was done, with either supportive therapy in the form of recombinant human erythropoiesis stimulating agents, colony stimulating factors, packed red blood cell support as needed for low risk MDS patients. High risk patients were treated with hypomethylating agents such as Azacytidine, Decitabine, or Lenalidomide. Results: The mean duration of follow-up of patients with MDS from the point of diagnosis was 1.8 years (range 4 months–6 years). The median OS was 1.33 years. The median OS in the analysis of our patient cohort with low, intermediate, high, and very high R-IPSS was 1.67 years, 1.33 years, 1.67 years, and 1.67 years, respectively. No patients of very low risk group were identified in our study. Conclusion: Our findings reflect that MDS-MLD with low or intermediate R-IPSS risk groups is the most common types of MDS. Although supportive therapy was used to treat patients irrespective of other therapy given (depending on the risk group of the patient), it was used alone even in higher risk groups due to logistic reasons in some cases. Those patients who received supportive care alone also had a good survival duration. However, a longer follow-up duration is required to firmly establish this outcome. The median age of patients (55 years) was also lower than established studies with a median overall survival of 1.67 years.

scholarly journals Does advanced maternal age influence obstetric outcome: a study in a tertiary care centre

2019 ◽  
Vol 8 (4) ◽  
pp. 1313
Author(s):  
Jose C. V. ◽  
Lissiamma George ◽  
Sunitha Sukumaran
Keyword(s):  
High Risk ◽  
Gestational Diabetes ◽  
Maternal Age ◽  
Tertiary Care ◽  
Advanced Maternal Age ◽  
Chronic Hypertension ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Younger Women ◽  
Medical Disorders

Background: Advanced maternal age defined as age 35 years and older at estimated date of delivery has become increasingly common in last two to three decades. The International Federation of Gynaecology and Obstetrics in 1958 recommended that all women going through their first pregnancy over the age of 35 years should be considered high risk for pregnancy and included in this category 1.Methods: A one-year prospective observational study conducted in a tertiary care hospital after institutional ethical clearance. All 165 women above 35yrs who delivered during this period were taken as Cohort 1. Same number of women aged between 20 and 34 years were randomly selected as comparison group (Cohort 2). Both the groups were compared in terms of preexisting medical disorders, obstetrical morbidities, antenatal complications, intrapartum complications.Results: Older and younger women had similar antenatal booking, occupational and socioeconomic status. The main reason for pregnancy at advanced age group was late marriage. The risk of chronic hypertension, gestational diabetes mellitus, pre-existing medical disorders were higher in advanced maternal age.Conclusions: Increasing maternal age is associated with elevated risks for pregnancy complications. They are at high risk for gestational diabetes, cesarean section and to have low birth weight babies. Since these women are at higher risk of complications, they should be advised to adhere to frequent antenatal visits and close supervision.

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.

High risk histopathological factors in retinoblastoma in upfront enucleated eyes: An experience from a tertiary care centre of Pakistan

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Nausheen Yaqoob ◽  
Salima Mansoor ◽  
Kanwal Aftab ◽  
Bushra Kaleem ◽  
Ahmer Hamid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Optic Nerve ◽  
High Risk ◽  
Anterior Chamber ◽  
Tertiary Care ◽  
Histologic Grade ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
High Risk Factors ◽  
Pathologic Staging

Background & Objectives: The assessment of histopathological risk factors (HRFs) in retinoblastoma in upfront enucleated eyes is important in deciding treatment protocols. Limited data is available from the developing countries as very few studies were conducted on retinoblastoma. The study aims to report this data from Pakistan. Methods: This cross-sectional study included treatment naïve retinoblastoma patients who underwent upfront enucleation between 2017 to 2021. Various tumor characteristics i.e. laterality, size, histologic grade, anaplasia grade, growth pattern, extent and length of optic nerve invasion, pathologic staging, tumor involvement of ocular structures were assessed. High-risk factors such as involvement of anterior chamber, choroidal, scleral, extrascleral, and optic nerve were also noted. Results: A total number of 54 patients were enrolled, out of which 53.7% were females while remaining were males. Median age at presentation was 24 months. Unilateral tumor was seen in 92.6% cases. Most frequent histologic grade was G2 (64.7%) and moderate anaplasia was observed in 59.2% cases. Vitreous involvement was seen in (86.5%). Pathologic staging of most of the tumors was pT1 (39.2%). Assessment of high-risk factors revealed that optic nerve involvement (35.1%) was the most common finding with retrolaminar tumor invasion seen in 75% cases. Choroidal invasion (≤3mm) was seen in 55.6% of patients. Limited involvement of anterior chamber (3.8%), sclera (7.4%), and extrascleral (3.8%) tissue was also observed. Conclusion: The presence of high risk histopathological factors in enucleated eyes diagnosed with retinoblastoma are known to have a profound impact on the risk stratification as well as decision of future treatment plan. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5787 How to cite this:Yaqoob N, Mansoor S, Aftab K, Kaleem B, Hamid A, Jamal S. High risk histopathological factors in retinoblastoma in upfront enucleated eyes: An experience from a tertiary care centre of Pakistan. Pak J Med Sci. 2022;38(2):369-374.  doi: https://doi.org/10.12669/pjms.38.ICON-2022.5787 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

High Frequency of High Risk CNAs in our Cohort of Pediatric B-ALL is Associated with Poor MRD and EFS: Data from a Tertiary Care Centre of India

2017 ◽  
Vol 17 ◽  
pp. S267
Author(s):  
Minu Singh ◽  
Prateek Bhatia ◽  
Amita Trehan ◽  
Neelam Verma ◽  
Manupdesh Singh Sachdeva ◽  
...  
Keyword(s):  
High Risk ◽  
High Frequency ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre
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