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Article: Assessment of National Early Warning Score 2 as a Tool to Predict the Outcome of COVID-19 Patients on Admission.

Chikhalkar, Balchandra / Gosain, Dhruv / Gaikwad, Shruti / Deshmukh, Rohit

2022 Volume 14, Issue 1, Page(s) e21164

Abstract: Introduction: The ongoing pandemic due to coronavirus disease 2019 (COVID-19) has put tremendous strain on the healthcare system around the world. There is a paucity of data describing the role of National Early Warning Score 2 (NEWS2) in the ... ...

Abstract	Introduction: The ongoing pandemic due to coronavirus disease 2019 (COVID-19) has put tremendous strain on the healthcare system around the world. There is a paucity of data describing the role of National Early Warning Score 2 (NEWS2) in the assessment of COVID-19 cases. This study aimed at identifying NEWS2 calculated on admission as a valuable tool for risk stratification and prediction of in-hospital mortality in COVID-19 patients. Materials and method: This prospective, observational study included 814 confirmed COVID-19 cases and was conducted over a period of three months. Vital parameters were assessed and NEWS2 was calculated on admission. Data were entered in excel format and statistical analysis was done in Python 3.8 statistical software (Wilmington, DE: Python Software Foundation). Pearson's chi-squared test was used following which a significant NEWS2 cut-off score to predict in-hospital mortality was determined by means of receiver operating characteristic (ROC) curve. Results: Mortality of 9.09% was noted and correlations were made with age, comorbidity, and NEWS2 score. For in-hospital deaths, comorbidities were present in 66.21% of patients, the mean age was 60.14 years, and average NEWS2 score was 9. For discharged patients only 21.89% had comorbidities, mean age was 42.96 years, and average NEWS2 score was 1.17. NEWS2 score of ≥ 6 had a sensitivity of 93.24% and specificity of 98.91%, and hence was a statistically significant cut-off value for predicting mortality on admission. Conclusion: Age, presence of comorbidities, and NEWS2 have a positive correlation with mortality in COVID-19 patients. NEWS2 score being easy, reliable, and quick to calculate, should be used to triage these patients on admission. Scores ≥ 6 should be considered to have a higher risk of adverse outcomes and hence should be managed prudently along with clinical judgment.
Language	English
Publishing date	2022-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.21164
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Article: SARS-CoV-2 Infection: A Possible Risk Factor for Incidence and Recurrence of Cancers.

Jafarzadeh, Abdollah / Gosain, Rohit / Mortazavi, Seyed Mohammad Javad / Nemati, Maryam / Jafarzadeh, Sara / Ghaderi, Abbas

International journal of hematology-oncology and stem cell research

2022 Volume 16, Issue 2, Page(s) 117–127

Abstract: COVID-19 and malignancy can affect the susceptibility of one another. Clinically recovered COVID-19 individuals display immune abnormalities that persist several months after discharge. The lymphopenia-related immunosuppression, functional exhaustion of ... ...

Abstract	COVID-19 and malignancy can affect the susceptibility of one another. Clinically recovered COVID-19 individuals display immune abnormalities that persist several months after discharge. The lymphopenia-related immunosuppression, functional exhaustion of cytotoxic lymphocytes (such as CD8
Language	English
Publishing date	2022-02-15
Publishing country	Iran
Document type	Journal Article ; Review
ZDB-ID	2652853-8
ISSN	2008-2207 ; 2008-3009
ISSN (online)	2008-2207
ISSN	2008-3009
DOI	10.18502/ijhoscr.v16i2.9205
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Article: Health-Related Quality of Life (HRQoL) in Neuroendocrine Tumors: A Systematic Review.

Gosain, Rohit / Gupta, Medhavi / Roy, Arya Mariam / Strosberg, Jonathan / Glaser, Kathryn M / Iyer, Renuka

Cancers

2022 Volume 14, Issue 6

Abstract: Therapeutic advancements in neuroendocrine tumors (NETs) have improved survival outcomes. This study aims to review the impact of the current therapeutics on health-related quality of life (HRQoL) in NET patients. A literature review was performed ... ...

Abstract	Therapeutic advancements in neuroendocrine tumors (NETs) have improved survival outcomes. This study aims to review the impact of the current therapeutics on health-related quality of life (HRQoL) in NET patients. A literature review was performed utilizing PubMed, The Cochrane Library, and EMBASE, using the keywords "Carcinoid", "Neuroendocrine tumor", "NET", "Quality of life", "Chemotherapy", "Chemoembolization", "Radiofrequency ablation", "Peptide receptor radionucleotide therapy", "PRRT", "Surgery", "Everolimus", "Octreotide", "Lanreotide", "Sunitinib", and "Somatostatin analog". Letters, editorials, narrative reviews, case reports, and studies not in English were excluded. Out of 2375 publications, 61 studies met our inclusion criteria. The commonly used instruments were EORTC QLQ-C30, FACT G, and EORTC- QLQ GI.NET-21. HRQoL was assessed in all pivotal trials that led to approvals of systemic therapies. All systemic therapies showed no worsening in HRQoL. The NETTER-1 study was the only study to show a statistically significant improvement in HRQoL in several domains. The trial examining sunitinib versus placebo in pancreatic NETs showed no change in QoL, except for worsening of diarrhea. In addition to clinical outcomes, patient-reported outcomes are a key element in making appropriate treatment decisions. HRQoL data should be readily provided to patients to assist in shared decision-making.
Language	English
Publishing date	2022-03-10
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14061428
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Article: Efficacy and Safety of Direct Oral Anticoagulants in Venous Thromboembolism Compared to Traditional Anticoagulants in Morbidly Obese Patients: A Systematic Review and Meta-Analysis.

Katel, Anjan / Aryal, Madan / Neupane, Arun / Gosain, Rohit / Pathak, Ranjan / Bhandari, Yashoda / Kouides, Peter

Cureus

2021 Volume 13, Issue 4, Page(s) e14572

Abstract: Background Randomized clinical trials comparing the efficacy and safety of direct oral anticoagulants (DOAC) with vitamin K antagonist (VKA) or low molecular weight heparin (LMWH) for the treatment of venous thromboembolism (VTE) generally exclude ... ...

Abstract	Background Randomized clinical trials comparing the efficacy and safety of direct oral anticoagulants (DOAC) with vitamin K antagonist (VKA) or low molecular weight heparin (LMWH) for the treatment of venous thromboembolism (VTE) generally exclude patients who are morbidly obese (body mass index ≥ 40 kg/m
Language	English
Publishing date	2021-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.14572
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Article: Incidence and Survival Outcomes in Patients with Lung Neuroendocrine Neoplasms in the United States.

Shah, Shrunjal / Gosain, Rohit / Groman, Adrienne / Gosain, Rahul / Dasari, Arvind / Halfdanarson, Thorvardur R / Mukherjee, Sarbajit

Cancers

2021 Volume 13, Issue 8

Abstract: Background: The incidence and prevalence of neuroendocrine neoplasms (NENs) are rapidly rising. Epidemiologic trends have been reported for common NENs, but specific data for lung NENs are lacking.: Methods: We conducted a retrospective analysis ... ...

Abstract	Background: The incidence and prevalence of neuroendocrine neoplasms (NENs) are rapidly rising. Epidemiologic trends have been reported for common NENs, but specific data for lung NENs are lacking. Methods: We conducted a retrospective analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Associated population data were utilized to report the annual age-adjusted incidence and overall survival (OS) trends. Trends for large-cell neuroendocrine carcinoma (LCNEC) and atypical carcinoid (AC) were reported from 2000-2015, while those for typical carcinoid (TC) and small cell lung cancer (SCLC) were reported from 1988-2015. Results: We examined a total of 124,969 lung NENs [103,890-SCLC; 3303-LCNEC; 8146-TC; 656-AC; 8974-Other]. The age-adjusted incidence rate revealed a decline in SCLC from 8.6 in 1988 to 5.3 in 2015 per 100,000; while other NENs showed an increase: TC increased from 0.57 in 1988 to 0.77 in 2015, AC increased from 0.17 in 2001 to 0.22 in 2015, and LCNEC increased from 0.16 in 2000 to 0.41 in 2015. The 5-year OS rate among SCLC, LCNEC, AC, and TC patients was 5%, 17%, 64%, and 84%, respectively. On multivariable analyses, OS and disease-specific survival (DSS) varied significantly by stage, sex, histological type, insurance type, marital status, and race, with a better survival noted in earlier stages, females, married, insured, Hispanic and other races, and urban population. Similarly, TC and AC had better survival compared to SCLC and LCNEC. Conclusion: The incidence of lung NENs is rising, possibly in part because of advanced radiological techniques. However, the incidence of SCLCs is waning, likely because of declining smoking habits. Such population-based studies are essential for resource allocation and to prioritize future research directions.
Language	English
Publishing date	2021-04-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers13081753
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Article ; Online: Lactic acidosis: a unique presentation of diffuse large B-cell lymphoma.

Mohammed, Turab Jawaid / Gosain, Rohit / Sharma, Rajeev / Torka, Pallawi

BMJ case reports

2019 Volume 12, Issue 10

Abstract: An elderly man in the seventh decade of life was brought to the hospital with worsening mental status. Blood tests revealed anaemia and thrombocytopenia with elevated lactate dehydrogenase and serum lactate levels. CT scan showed bulky thoracic and ... ...

Abstract	An elderly man in the seventh decade of life was brought to the hospital with worsening mental status. Blood tests revealed anaemia and thrombocytopenia with elevated lactate dehydrogenase and serum lactate levels. CT scan showed bulky thoracic and abdominal lymphadenopathy with splenomegaly. A positron emission tomography scan confirmed the above and in addition, revealed bilateral adrenal involvement. Bone marrow biopsy revealed non-germinal centre B-cell-like (non-GCB)-diffuse large B-cell lymphoma (DLBCL). Prompt treatment with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab with intrathecal methotrexate chemotherapy resulted in a dramatic improvement in the patient's condition. This vignette serves as a reminder to include aggressive lymphomas like DLBCL in the differential diagnoses of patients presenting with metabolic encephalopathy and lactic acidosis. Our patient was moribund at presentation with poor sensorium and failure to thrive. The dilemma was whether to take an aggressive stand and start chemotherapy urgently or whether to stabilise the patient first and then consider the treatment of DLBCL. We make a case for initiating therapy promptly in such patients irrespective of their performance status.
MeSH term(s)	Acidosis, Lactic/etiology ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Brain Diseases, Metabolic/etiology ; Diagnosis, Differential ; Humans ; Lymphoma, Large B-Cell, Diffuse/complications ; Lymphoma, Large B-Cell, Diffuse/drug therapy ; Male
Language	English
Publishing date	2019-10-25
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-230277
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Article: Interleukin-6 as a biomarker in patients with hepatobiliary cancers.

Gosain, Rohit / Anwar, Sidra / Miller, Austin / Iyer, Renuka / Mukherjee, Sarbajit

Journal of gastrointestinal oncology

2019 Volume 10, Issue 3, Page(s) 537–545

Abstract: Background: The role of inflammation has been well established in many cancers, including hepatobiliary cancers. Elevated levels of interleukin-6 (IL-6), a pro-inflammatory marker, are associated with poor overall survival (OS) in hepatocellular ... ...

Abstract	Background: The role of inflammation has been well established in many cancers, including hepatobiliary cancers. Elevated levels of interleukin-6 (IL-6), a pro-inflammatory marker, are associated with poor overall survival (OS) in hepatocellular carcinoma (HCC) patients. Methods: We performed a study to establish the role of IL-6 as a prognostic biomarker in both HCC and biliary cancer patients and further assessed the impact of IL-6 on pain score and performance status, two parameters that affect the quality of life. We evaluated 91 patients with newly diagnosed unresectable hepatobiliary cancer and compared them with age, gender and BMI matched healthy controls. Results: We found that IL-6 levels were elevated in hepatobiliary cancer patients compared to healthy controls. Higher levels of IL-6 were associated with poor prognosis, elevated pain scores and poor performance status in patients. Interestingly, we found an association between elevated IL-6 levels and the presence of portal vein thrombosis (PVT) at the time of cancer diagnosis. Conclusions: This study suggests that IL-6 is an important prognostic biomarker in hepatobiliary cancers, where elevated levels are not only associated with a worse survival but also linked to an inferior quality of life.
Language	English
Publishing date	2019-06-04
Publishing country	China
Document type	Journal Article
ZDB-ID	2594644-4
ISSN	2219-679X ; 2078-6891
ISSN (online)	2219-679X
ISSN	2078-6891
DOI	10.21037/jgo.2019.01.09
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Article ; Online: Geographic and Demographic Disparities in Colorectal Cancer: A National Cancer Database Analysis.

Mohammed, Turab / Gosain, Rohit / Rana, Navpreet / Lemini, Riccardo / Wang, Katy / Agha, Asna / Neupane, Arun / Gabriel, Emmanuel M / Nurkin, Steven / Boland, Patrick

Hematology/oncology and stem cell therapy

2023 Volume 16, Issue 3, Page(s) 262–271

Abstract: Background and objectives: Area of residence may adversely affect survival and outcomes in many cancers. The objective of this study was to evaluate the impact of geographical and demographic disparities on survival of patients with colorectal cancer.!## ...

Abstract	Background and objectives: Area of residence may adversely affect survival and outcomes in many cancers. The objective of this study was to evaluate the impact of geographical and demographic disparities on survival of patients with colorectal cancer. Materials and methods: Data were obtained from the National Cancer Database (NCDB) colon, rectosigmoid, and rectal datasets. Patients were categorized by area of residence, namely, metropolitan (MA), urban (UA), or rural (RA). Sociodemographic and tumor-related data were collected and analyzed to evaluate variables affecting overall survival (OS). Results: In total, 973,139 patients between 2004 and 2013 were included in the study, of which 83%, 15%, and 2% were MA, UA, and RA residents, respectively. RA and UA patients were mostly white male with low income and no comorbidities. In univariate analysis, OS was worse for RA (hazard ratio [HR] 1.10) and UA (HR 1.06) colorectal cancer patients than that for MA colorectal cancer patients. In multivariate analysis revealed significant association between OS and geographic residence, with worse OS for RA (HR 1.02, p = 0.04) and UA (HR 1.01, p = 0.003) patients. Black (HR 1.14) and Native American (HR 1.17) patients had worse outcomes, while Asians (HR 0.8), women (HR 0.88), and patients with higher income had improved OS (HR 0.88). Conclusion: The differences in the OS for RA and UA patients with colorectal cancer were significantly driven by economic disparity. Area of residence represents an important factor independently limiting access to care, particularly in geographically isolated individuals.
MeSH term(s)	Humans ; Male ; Female ; Comorbidity ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/therapy ; Demography
Language	English
Publishing date	2023-04-04
Publishing country	Saudi Arabia
Document type	Journal Article
ZDB-ID	2651893-4
ISSN	2589-0646 ; 1658-3876
ISSN (online)	2589-0646
ISSN	1658-3876
DOI	10.56875/2589-0646.1061
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Article ; Online: Stress reduction strategies in breast cancer: review of pharmacologic and non-pharmacologic based strategies.

Gosain, Rohit / Gage-Bouchard, Elizabeth / Ambrosone, Christine / Repasky, Elizabeth / Gandhi, Shipra

Seminars in immunopathology

2020 Volume 42, Issue 6, Page(s) 719–734

Abstract: Breast cancer is the most common cancer diagnosed in women. It is associated with multiple symptoms in both patients and caregivers, such as stress, anxiety, depression, sleep disturbance, and fatigue. Stress appears to promote cancer progression via ... ...

Abstract	Breast cancer is the most common cancer diagnosed in women. It is associated with multiple symptoms in both patients and caregivers, such as stress, anxiety, depression, sleep disturbance, and fatigue. Stress appears to promote cancer progression via activation of the sympathetic nervous system releasing epinephrine and norepinephrine as well as activation of hypothalamic-pituitary-adrenal axis releasing cortisol. These stress hormones have been shown to promote the proliferation of cancer cells. This review focuses on stress-reducing strategies which may decrease cancer progression by abrogating these pathways, with a main focus on the β-adrenergic signaling pathway. Patients utilize both non-pharmacologic and pharmacologic strategies to reduce stress. Non-pharmacologic stress-reduction strategies include complementary and alternative medicine techniques, such as meditation, yoga, acupuncture, exercise, use of natural products, support groups and psychology counseling, herbal compounds, and multivitamins. Pharmacologic strategies include abrogating the β2-adrenergic receptor signaling pathway to antagonize epinephrine and norepinephrine action on tumor and immune cells. β-Blocker drugs may play a role in weakening the pro-migratory and pro-metastatic effects induced by stress hormones in cancer and strengthening the anti-tumor immune response. Preclinical models have shown that non-selective β1/2-blocker use is associated with a decrease in tumor growth and metastases and clinical studies have suggested their positive impact on decreasing breast cancer recurrence and mortality. Thus, non-pharmacological approaches, along with pharmacological therapies part of clinical trials are available to cancer patients to reduce stress, and have promise to break the cycle of cancer and stress.
MeSH term(s)	Breast Neoplasms/drug therapy ; Fatigue ; Female ; Humans ; Hypothalamo-Hypophyseal System ; Neoplasm Recurrence, Local ; Pituitary-Adrenal System
Language	English
Publishing date	2020-09-18
Publishing country	Germany
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2316828-6
ISSN	1863-2300 ; 1863-2297
ISSN (online)	1863-2300
ISSN	1863-2297
DOI	10.1007/s00281-020-00815-y
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Article ; Online: COVID-19 and Cancer: a Comprehensive Review.

Gosain, Rohit / Abdou, Yara / Singh, Abhay / Rana, Navpreet / Puzanov, Igor / Ernstoff, Marc S

Current oncology reports

2020 Volume 22, Issue 5, Page(s) 53

Abstract: Purpose of review: The outbreak of the novel coronavirus disease 2019 (COVID-19) has emerged to be the biggest global health threat worldwide, which has now infected over 1.7 million people and claimed more than 100,000 lives around the world. Under ... ...

Abstract	Purpose of review: The outbreak of the novel coronavirus disease 2019 (COVID-19) has emerged to be the biggest global health threat worldwide, which has now infected over 1.7 million people and claimed more than 100,000 lives around the world. Under these unprecedented circumstances, there are no well-established guidelines for cancer patients. Recent findings: The risk for serious disease and death in COVID-19 cases increases with advancing age and presence of comorbid health conditions. Since the emergence of the first case in Wuhan, China, in December 2019, tremendous research efforts have been underway to understand the mechanisms of infectivity and transmissibility of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a fatal virus responsible for abysmal survival outcomes. To minimize the mortality rate, it becomes prudent to identify symptoms promptly and employ treatments appropriately. Even though no cure has been established, multiple clinical trials are underway to determine the most optimal strategy. Managing cancer patients under these circumstances is rather challenging, given their vulnerable status and the aggressive nature of their underlying disease. In this comprehensive review, we discuss the impact of COVID-19 on health and the immune system of those affected, reviewing the latest treatment approaches and ongoing clinical trials. Additionally, we discuss challenges faced while treating cancer patients and propose potential approaches to manage this vulnerable population during this pandemic.
MeSH term(s)	Antiviral Agents/therapeutic use ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/drug therapy ; Coronavirus Infections/epidemiology ; Coronavirus Infections/transmission ; Hospital Mortality ; Humans ; Immunocompromised Host ; Neoplasms/epidemiology ; Neoplasms/immunology ; Pandemics ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/transmission ; Risk Factors ; SARS-CoV-2
Chemical Substances	Antiviral Agents
Keywords	covid19
Language	English
Publishing date	2020-05-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057359-5
ISSN	1534-6269 ; 1523-3790
ISSN (online)	1534-6269
ISSN	1523-3790
DOI	10.1007/s11912-020-00934-7
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