@php $reservationId = $AnalysisPackage->END_USER_LAB_ORDER_ID; $identification = $AnalysisPackage->IDENTIFICATION; $labCategoryId = $AnalysisPackage->LAB_CATEGORY_PACKAGE_ID; // Expand IDs to check for test-specific questionnaires $idsToCheck = [$labCategoryId]; $package = \App\Models\LABCATEGORYPACKAGE::find($labCategoryId); if ($package && $package->IS_PACKAGE) { $itemIds = \App\Models\LABPACKAGEITEM::where('PACKAGE_ID', $labCategoryId)->pluck('LAB_CATEGORY_PACKAGE_ID')->toArray(); $idsToCheck = array_merge($idsToCheck, $itemIds); } $questionsWithAnswers = App\Models\ENDUSERPACKAGEQUESTIONNAIREANSWERS::where('END_USER_LAB_ORDER_ID', $reservationId) ->where('IDENTIFICATION', $identification) ->whereIn('LAB_CATEGORY_PACKAGE_ID', $idsToCheck) ->with(['question.options']) ->whereDoesntHave('question', function ($query) { $query->where('HIDE_FROM_REPORT', 1) ->orWhereIn('TYPE', ['FILE', 'DOWNLOAD_FILE']); }) ->get(); foreach ($questionsWithAnswers as $item) { $item->SELECTED_OPTIONS = $item->selectedOptionsNames; } $LabCategoryPackageResults = App\Models\ENDUSERLABORDERPACKAGERESULT::where('END_USER_PACKAGE_ID',$Package->ID)->with('Option','Result')->get(); $chromosomes = []; $fetalFraction = null; $sex = null; $gender = 0; $resultDate = []; $sex_chromosomes = []; $syndrome = []; foreach ($LabCategoryPackageResults as $key => $LabCategoryPackageResult) { if($LabCategoryPackageResult->Result->CODE == 'FF' && !empty($LabCategoryPackageResult->RESULT)) { $fetalFraction = $LabCategoryPackageResult->RESULT.'%'; } if($LabCategoryPackageResult->Result->CODE == 'SC' && $LabCategoryPackageResult->OPTION_ID) { $sex = $LabCategoryPackageResult->Option->NAME_EN; if ($sex == "Male, XY") $gender = 1; if ($sex == "Female, XX") $gender = 2; } if($LabCategoryPackageResult->Result->CODE == 'Result' && !empty($LabCategoryPackageResult->OPTION_ID)) { $resultDate['result'] = $LabCategoryPackageResult->Option->NAME_EN; $resultDate['isNormal'] = $LabCategoryPackageResult->Option->IS_NORMAL; } if($LabCategoryPackageResult->Result->CODE == '45X' && !empty($LabCategoryPackageResult->OPTION_ID)) { $sex_chromosomes['45X'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == '47XXX' && !empty($LabCategoryPackageResult->OPTION_ID)) { $sex_chromosomes['47XXX'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == '47XXY' && !empty($LabCategoryPackageResult->OPTION_ID)) { $sex_chromosomes['47XXY'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == '47XYY' && !empty($LabCategoryPackageResult->OPTION_ID)) { $sex_chromosomes['47XYY'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'T21' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['T21'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'T18' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['T18'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'T13' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['T13'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'bg13' && !empty($LabCategoryPackageResult->RESULT)) { $syndrome['bg13'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'bg18' && !empty($LabCategoryPackageResult->RESULT)) { $syndrome['bg18'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'bg21' && !empty($LabCategoryPackageResult->RESULT)) { $syndrome['bg21'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'zs13' && !empty($LabCategoryPackageResult->RESULT)) { $syndrome['zs13'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'zs18' && !empty($LabCategoryPackageResult->RESULT)) { $syndrome['zs18'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'zs21' && !empty($LabCategoryPackageResult->RESULT)) { $syndrome['zs21'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'PKS' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['PKS'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'JS' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['JS'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'DWS' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['DWS'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'q26' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['q26'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'p36' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['p36'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'CDC' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['CDC'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'WAGRO' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['WAGRO'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'q21' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['q21'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'DGS2' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['DGS2'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'LGS' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['LGS'] = $LabCategoryPackageResult->Option->CODE; } if($LabCategoryPackageResult->Result->CODE == 'LGS' && !empty($LabCategoryPackageResult->OPTION_ID)) { $syndrome['LGS'] = $LabCategoryPackageResult->Option->CODE; } if(str_contains($LabCategoryPackageResult->Result->CODE,'Chromosome')) { for ($i = 1; $i <= 22; $i++) { $code = 'Chromosome'.$i; if($LabCategoryPackageResult->Result->CODE == $code && !empty($LabCategoryPackageResult->OPTION_ID)) { $chromosomes[$code] = $LabCategoryPackageResult->Option->CODE; } } } if($LabCategoryPackageResult->Result->CODE == 'ACSCOM' && !empty($LabCategoryPackageResult->RESULT)) { $syndrome['ACSCOM'] = $LabCategoryPackageResult->RESULT; } } $chromosomesRec = []; $sexChromosomesRec = []; $trisomyRec = []; foreach ($LabCategoryPackageResults as $key => $LabCategoryPackageResult) { if(str_contains($LabCategoryPackageResult->Result->CODE,'rcc')) { for ($i = 1; $i <= 22; $i++) { $code = 'rcc'.$i; if($LabCategoryPackageResult->Result->CODE == $code && !empty($LabCategoryPackageResult->RESULT)) { $chromosomesRec['Chromosome'.$i] = $LabCategoryPackageResult->RESULT; } } } // Sex chromosome recommendations if($LabCategoryPackageResult->Result->CODE == 'rc47XYY' && !empty($LabCategoryPackageResult->RESULT)) { $sexChromosomesRec['47XYY'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'rc47XXY' && !empty($LabCategoryPackageResult->RESULT)) { $sexChromosomesRec['47XXY'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'rc45X' && !empty($LabCategoryPackageResult->RESULT)) { $sexChromosomesRec['45X'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'rc47XXX' && !empty($LabCategoryPackageResult->RESULT)) { $sexChromosomesRec['47XXX'] = $LabCategoryPackageResult->RESULT; } // Trisomy recommendations if($LabCategoryPackageResult->Result->CODE == 'rcT21' && !empty($LabCategoryPackageResult->RESULT)) { $trisomyRec['T21'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'rcT18' && !empty($LabCategoryPackageResult->RESULT)) { $trisomyRec['T18'] = $LabCategoryPackageResult->RESULT; } if($LabCategoryPackageResult->Result->CODE == 'rcT13' && !empty($LabCategoryPackageResult->RESULT)) { $trisomyRec['T13'] = $LabCategoryPackageResult->RESULT; } } if ($gender == 1) { $color = "#D3EAFD"; $section_color = hexToRgb($Profile->COLOR,0.2) ?? 'rgba(244, 248, 255, 1)'; $img = url('/images/boy.png'); } elseif($gender == 2) { $color = "#FCECF6"; $section_color = hexToRgb($Profile->COLOR,0.2) ?? 'rgba(252, 236, 246, 0.5)'; $img = url('/images/girl.png'); } else{ $color = "#E5E2E2"; $section_color = hexToRgb($Profile->COLOR,0.2) ?? 'rgba(128, 128, 128, 0.1)'; $img = url('/img/gender_symbol.png'); } $bgExist = false; if(!empty($syndrome['bg13']) || !empty($syndrome['bg18']) || !empty($syndrome['bg21'])) $bgExist = true; // Calculate overall result based on all chromosomes and syndromes $hasHighRisk = false; // Check sex chromosomes for high risk foreach ($sex_chromosomes as $value) { if ($value == 'high') { $hasHighRisk = true; break; } } // Check autosomal chromosomes for high risk if (!$hasHighRisk) { foreach ($chromosomes as $value) { if ($value == 'high') { $hasHighRisk = true; break; } } } // Check syndromes for high risk if (!$hasHighRisk) { if (!empty($syndrome['T21']) && $syndrome['T21'] == 'high') $hasHighRisk = true; if (!empty($syndrome['T18']) && $syndrome['T18'] == 'high') $hasHighRisk = true; if (!empty($syndrome['T13']) && $syndrome['T13'] == 'high') $hasHighRisk = true; if (!empty($syndrome['PKS']) && $syndrome['PKS'] == 'high') $hasHighRisk = true; if (!empty($syndrome['JS']) && $syndrome['JS'] == 'high') $hasHighRisk = true; if (!empty($syndrome['DWS']) && $syndrome['DWS'] == 'high') $hasHighRisk = true; if (!empty($syndrome['q26']) && $syndrome['q26'] == 'high') $hasHighRisk = true; if (!empty($syndrome['p36']) && $syndrome['p36'] == 'high') $hasHighRisk = true; if (!empty($syndrome['CDC']) && $syndrome['CDC'] == 'high') $hasHighRisk = true; if (!empty($syndrome['WAGRO']) && $syndrome['WAGRO'] == 'high') $hasHighRisk = true; if (!empty($syndrome['q21']) && $syndrome['q21'] == 'high') $hasHighRisk = true; if (!empty($syndrome['DGS2']) && $syndrome['DGS2'] == 'high') $hasHighRisk = true; if (!empty($syndrome['LGS']) && $syndrome['LGS'] == 'high') $hasHighRisk = true; } // Set result based on calculated risk if ($hasHighRisk) { $resultDate['result'] = 'High Risk'; $resultDate['isNormal'] = 0; } else { $resultDate['result'] = 'Low Risk'; $resultDate['isNormal'] = 1; } @endphp @if($questionsWithAnswers->count() > 0)
PATIENT CLINICAL DATA
@endif @foreach($questionsWithAnswers->chunk(4) as $chunk)
@foreach($chunk as $questionAnswer)
{{$questionAnswer->question->NAME_EN}}: @if(!empty($questionAnswer->SELECTED_OPTIONS)) @foreach($questionAnswer->SELECTED_OPTIONS as $selectedOption) {{$selectedOption}} @if(!empty($questionAnswer->DESCRIPTION)) {{$questionAnswer->DESCRIPTION}} @endif @endforeach @else {{$questionAnswer->ANSWER}} @endif
@endforeach
@endforeach

REPORT SUMMARY

Result
{{$resultDate['result']}}
@if($resultDate['isNormal'] != 1) D @else N @endif
Fetal Sex
@if($gender == 1) Male @elseif($gender == 2) Female @else Unknown @endif
@if($gender == 1) @elseif($gender == 2) @else @endif
Fetal Fraction
{{$fetalFraction}}
@if(!empty($syndrome['T21']) || !empty($syndrome['T18']) || !empty($syndrome['T13']))

RESULTS

Syndrome
@if($bgExist)
Background Risk
NIPTune RISK SCORE
@endif
Clinical Interpretation
Recommendation
@if(!empty($syndrome['T21']))
Trisomy 21

( Down’s Syndrome)
@if($bgExist)
@if(!empty($syndrome['bg21'])) {{$syndrome['bg21'] }} @endif
less than 1:100000
(< 0.01%)
@endif
@if($syndrome['T21'] == 'low') Low Risk @else High Risk @endif
@php $recT21 = $trisomyRec['T21'] ?? 'Test'; @endphp {{ $recT21 }}
@endif @if(!empty($syndrome['T18']))
Trisomy 18

( Edward’s Syndrome)
@if($bgExist)
@if(!empty($syndrome['bg18'])) {{$syndrome['bg18'] }} @endif
less than 1:100000
(< 0.01%)
@endif
@if($syndrome['T18'] == 'low') Low Risk @else High Risk @endif
@php $recT18 = $trisomyRec['T18'] ?? 'Test'; @endphp {{ $recT18 }}
@endif @if(!empty($syndrome['T13']))
Trisomy 13

( Patau’s Syndrome)
@if($bgExist)
@if(!empty($syndrome['bg13'])) {{$syndrome['bg13'] }} @endif
less than 1:100000
(< 0.01%)
@endif
@if($syndrome['T13'] == 'low') Low Risk @else High Risk @endif
@php $recT13 = $trisomyRec['T13'] ?? 'Test'; @endphp {{ $recT13 }}
@endif
@endif
Fetal Sex
@if($gender == 1) Male @elseif($gender == 2) Female @else Unknown @endif
Chromosome Results
{{explode(',', $sex)[1]??null}}
Estimated Fetal Fraction
{{$fetalFraction}}
@if($Profile->ID == 66)

Note:
Detected -high risk of Aneuploidy identified
Not Detected- Low risk of Aneuploidy identified

@endif
@if(!empty($sex_chromosomes['45X']) || !empty($sex_chromosomes['47XXX']) || !empty($sex_chromosomes['47XXY']) || !empty($sex_chromosomes['47XYY']))
Sex Chromosome Aneuploidies
Result
Recommendation
@if(!empty($sex_chromosomes['45X']))
45, X (Turner Syndrome)
@if($sex_chromosomes['45X'] == 'low') Low Risk @elseif($sex_chromosomes['45X'] == 'high') High Risk @else N/A @endif
@php $rec45X = $sexChromosomesRec['45X'] ?? ''; if(empty($rec45X)) { $rec45X = $sex_chromosomes['45X'] == 'high' ? 'Genetic counseling recommended' : 'Routine prenatal care'; } @endphp {{ $rec45X }}
@endif @if(!empty($sex_chromosomes['47XXX']))
47, XXX (Trisomy X Syndrome)
@if($sex_chromosomes['47XXX'] == 'low') Low Risk @elseif($sex_chromosomes['47XXX'] == 'high') High Risk @else N/A @endif
@php $rec47XXX = $sexChromosomesRec['47XXX'] ?? ''; if(empty($rec47XXX)) { $rec47XXX = $sex_chromosomes['47XXX'] == 'high' ? 'Genetic counseling recommended' : 'Routine prenatal care'; } @endphp {{ $rec47XXX }}
@endif @if(!empty($sex_chromosomes['47XXY']))
47, XXY (Klinefelter's Syndrome)
@if($sex_chromosomes['47XXY'] == 'low') Low Risk @elseif($sex_chromosomes['47XXY'] == 'high') High Risk @else N/A @endif
@php $rec47XXY = $sexChromosomesRec['47XXY'] ?? ''; if(empty($rec47XXY)) { $rec47XXY = $sex_chromosomes['47XXY'] == 'high' ? 'Genetic counseling recommended' : 'Routine prenatal care'; } @endphp {{ $rec47XXY }}
@endif @if(!empty($sex_chromosomes['47XYY']))
47, XYY (Jacob's Syndrome)
@if($sex_chromosomes['47XYY'] == 'low') Low Risk @elseif($sex_chromosomes['47XYY'] == 'high') High Risk @else N/A @endif
@php $rec47XYY = $sexChromosomesRec['47XYY'] ?? ''; if(empty($rec47XYY)) { $rec47XYY = $sex_chromosomes['47XYY'] == 'high' ? 'Genetic counseling recommended' : 'Routine prenatal care'; } @endphp {{ $rec47XYY }}
@endif
@endif @if(!empty($chromosomes))
Autosomal Aneuploidies
Result
Recommendation
@foreach ($chromosomes as $chromosome => $value) @php $recommendation = $chromosomesRec[$chromosome] ?? ''; if(empty($recommendation)) { $recommendation = $value == 'high' ? 'Confirmatory testing advised' : 'Routine prenatal care'; } @endphp
{{ $chromosome }}
@if($value == 'low') Low Risk @elseif($value == 'high') High Risk @else N/A @endif
{{ $recommendation }}
@endforeach
@endif
@if(!empty($syndrome['LGS']) || !empty($syndrome['DGS2']) || !empty($syndrome['q21']) || !empty($syndrome['WAGRO']) || !empty($syndrome['CDC']) || !empty($syndrome['p36']) || !empty($syndrome['q26']) || !empty($syndrome['DWS']) || !empty($syndrome['JS']) || !empty($syndrome['PKS']))
MICRODELETION/DUPLICATION SYNDROMES
Syndrome
Result
@if(!empty($syndrome['PKS']))
Pallister-Killian Syndrome (PKS)
@if($syndrome['PKS'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['JS']))
Jacobsen Syndrome
@if($syndrome['JS'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['DWS']))
Dandy-Walker Syndrome
@if($syndrome['DWS'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['q26']))
15q26-qter Levy-Shanske Syndrome
@if($syndrome['q26'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['p36']))
1p36 Microdeletion Syndrome Levy-Shanske Syndrome
@if($syndrome['p36'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['CDC']))
Cri-du-chat Syndrome
@if($syndrome['CDC'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['WAGRO']))
WAGRO Syndrome
@if($syndrome['WAGRO'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['q21']))
4q21 Microdeletion Syndrome
@if($syndrome['q21'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['DGS2']))
DiGeorge Syndrome 2
@if($syndrome['DGS2'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['LGS']))
Langer-Giedion Syndrome
@if($syndrome['LGS'] == 'low') Low Risk @else High Risk @endif
@endif @if(!empty($syndrome['ACSCOM']))

Comment: {!! nl2br(e($syndrome['ACSCOM'])) !!}

@endif
@endif @include('pdf.integrated_report.components.analysis_tests.layout.comment')