Correlation of SARS-Cov2 viral load with severity of COVID-19 disease in pregnant women at term: an observational study

Background: COVID-19 disease raised global health concerns especially for the pregnant women who are more susceptible to respiratory viral illnesses due to their bodily immunological and physiological changes to accommodate the foetus. The aim of the study is to evaluate the relationship between the SARS-CoV 2 specific RdRp gene Ct values ​​and the severity of the COVID-19 disease in SARS-CoV2 positive pregnant women at term. Methods: A retrospective cohort study was conducted in the Department of Microbiology, Government Medical College, Amritsar on a subset of 46 COVID-19 positive, ante natal mothers, who presented in the labour room for delivery from August 2020 to January 2022. Results: A cohort of 4.8% (46/949) women tested positive in the RT-PCR test for viral RNA. Average age of the group was 25.5years and 89.1% were asymptomatic. 10.9% women reported mild symptoms and 95% had no pre-existing co morbidities. Obstetric complications like premature rupture of membranes were 4.3%, pre-term births 17.33%. Miscarriage and IUD was recorded in 4.34% and 2.17% patients respectively. When compared to values seen in symptomatic women with fever (Ct 25.8), dyspnoea (Ct 28.7), and respiratory distress (Ct 29.1), the mean Ct value reported in asymptomatic women (27.49 SD+5.4) was identical. SARS-CoV2 was not present in any newborns. Despite 24% having low birth weights for their gestational ages, 93% of babies were asymptomatic. Conclusions: The severity of the COVID-19 illness did not correspond with the SARS CoV2 virus RdRp gene Ct levels. The presence of SARS-CoV2 did not appear to independently cause poor maternal and new-born outcomes

Trimodality Treatment of Extremity Soft Tissue Sarcoma: Where Do We Go Now?

Extremity soft tissue sarcoma (ESTS) constitutes the majority of patients with soft tissue sarcoma (STS). Patients with localized high-grade ESTS \u3e 5 cm in size carry a substantial risk of developing distant metastasis on follow-up. A neoadjuvant chemoradiotherapy approach can enhance local control by facilitating resection of the large and deep locally advanced tumors while trying to address distant spread by treating the micrometastasis for these high-risk ESTS. Preoperative chemoradiotherapy and adjuvant chemotherapy are often used for children with intermediate- or high-risk non-rhabdomyosarcoma soft tissue tumors in North America and Europe. In adults, the cumulative evidence supporting preoperative chemoradiotherapy or adjuvant chemotherapy remains controversial. However, some studies support a possible benefit of 10% in overall survival (OS) for high-risk localized ESTS, especially for those with a probability of 10-year OS \u3c 60% using validated nomograms. Opponents of neoadjuvant chemotherapy argue that it delays curative surgery, compromises local control, and increases the rate of wound complications and treatment-related mortality; however, the published trials do not support these arguments. Most treatment-related side effects can be managed with adequate supportive care. A coordinated multidisciplinary approach involving sarcoma expertise in surgery, radiation, and chemotherapy is required to achieve better outcomes for ESTS. The next generation of clinical trials will shed light on how comprehensive molecular characterization, targeted agents and/or immunotherapy can be integrated into the upfront trimodality treatment to improve outcomes. To that end, every effort should be made to enroll these patients on clinical trials, when available

Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis.

Objective was to determine whether prophylactic low level laser therapy (LLLT) reduces the risk of severe mucositis as compared to placebo or no therapy.MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched until February 2014 for randomized controlled trials (RCTs) comparing prophylactic LLLT with placebo or no therapy in patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT). All analyses used random effects models.Eighteen RCTs (1144 patients) were included. Prophylactic LLLT reduced the overall risk of severe mucositis (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.20 to 0.67; P = 0.001). LLLT also reduced the following outcomes when compared to placebo/no therapy: severe mucositis at the time of anticipated maximal mucositis (RR 0.34, 95% CI 0.20 to 0.59), overall mean grade of mucositis (standardized mean difference -1.49, 95% CI -2.02 to -0.95), duration of severe mucositis (weighted mean difference -5.32, 95% CI -9.45 to -1.19) and incidence of severe pain (RR 0.26, 95% CI 0.18 to 0.37).Prophylactic LLLT reduced severe mucositis and pain in patients with cancer and HSCT recipients. Future research should identify the optimal characteristics of LLLT and determine feasibility in the clinical setting

Effect of low level laser therapy as compared to placebo/no therapy on overall incidence of severe (grade 3 or 4) mucositis stratified by patient, laser and risk of bias characteristics.

<p>Abbreviations: RR – risk ratio; CI – confidence interval; HSCT – hematopoietic stem cell transplantation.</p>¥<p>All analyses used a random-effect model. A risk ratio <1 with 95% CIs that do not include 1, suggests that low level laser is better than placebo/no therapy.</p><p>Effect of low level laser therapy as compared to placebo/no therapy on overall incidence of severe (grade 3 or 4) mucositis stratified by patient, laser and risk of bias characteristics.</p

Summary of outcomes of low level laser therapy as compared to placebo/no treatment.

<p>Abbreviations: RR - risk ratio; SMD - standardized mean difference; WMD – weighted mean difference; CI – confidence interval;</p><p>*Maximum anticipated mucositis was week 6±1 in head and neck cancer radiotherapy/chemo-radiotherapy trials and day 10±4 in chemotherapy and hematopoietic stem cell transplantation trials (from date of chemotherapy initiation and stem cell infusion respectively).</p><p>** Severe pain defined as a visual analogue scale score >7.</p>¥<p>All analyses used a random-effect model. A risk ratio <1 and a standardized mean difference or weighted mean difference <0 with 95% CIs that do not include 1 or 0 respectively, suggest that low level laser is better than placebo/no therapy.</p><p>Summary of outcomes of low level laser therapy as compared to placebo/no treatment.</p

Flow diagram of trial identification and selection.

<p>Flow diagram of trial identification and selection.</p

Baseline characteristics of studies included in the meta-analysis^*.

<p>Abbreviations: Allo - allogeneic hematopoietic stem cell transplant; Auto-autologous hematopoietic stem cell transplant; Chemo – chemotherapy; EORTC-European Organization for Research and Treatment of Cancer; GaAIAs/AsGaAI – gallium-aluminium-arsenide/arsenate; He-Ne- helium-neon; HSCT – hematopoietic stem cell transplantation; InGaAIP – indium-gallium-aluminium phosphide; LED – light emitting diode; NA – not available; NCI CTC – National Cancer Institute Common Terminology Criteria; OMAS – Oral Mucositis Assessment Scale; OMI - Oral Mucositis Index; Pub – published; Radio- radiotherapy; RTOG – Radiation Therapy Oncology Group; VAS – visual analog scale; WHO – World Health Organization.</p><p>*There were 18 studies reporting 19 separate comparisons between low level light therapy and placebo/no therapy as one study stratified the population by underlying disease diagnosis and HSCT regimen.</p><p>Baseline characteristics of studies included in the meta-analysis^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0107418#nt102" target="_blank">*</a>}.</p

Funnel plot “trim and fill” technique assessing publication bias for overall incidence of severe mucositis.

<p>The x-axis represents the risk ratio for the effect of low level laser therapy and the y-axis represents the inverse of the variance of the effect. Estimated number of missing studies on right side = 4.</p

Forest plot of overall incidence of severe (grade 3 or 4) mucositis.

<p>Squares to the left of the vertical line indicate that low level laser therapy reduces mucositis. Horizontal lines through the squares represent 95% confidence intervals (CIs). The size of the squares reflects each study's relative weight, and the diamond represents the aggregate risk ratio and 95% CI.</p