Improved Survival and Quality of Life Through an Integrative, Multidisciplinary Oncological Approach: Pathophysiological Analysis of Four Clinical Cancer Cases and Review of the Literature.

Objectives: According to the National Cancer Institute, the integrative medicine (IM) approach to medical care combines standard medicine with complementary and alternative medicine practices that have proved safe and effective. Methods: We describe the clinical cases of four patients with malignant pleural mesothelioma (MPM), diffuse malignant peritoneal mesothelioma (DMPM), intrahepatic cholangiocarcinoma, and breast cancer (BC) who received supportive treatment (ST) according to an IM approach after the failure of standard cancer treatments or the appearance of serious adverse events caused by antiblastic chemotherapy. The critical role of complementary drugs in reducing the side effects of cancer treatments and normalizing the white cell count is especially apparent in the case of the patient with metastatic BC, who experienced prolonged neutropenia. Results: The IM approach was well-tolerated and had no adverse side effects. It improved the quality of life (QoL) of all patients and in two cases extended overall survival. Conclusion: The extended clinical and instrumental response to IM of the patients with malignant mesothelioma and the improved health-related QoL and good tolerance of the ST demonstrated in all cases support the value of this approach in patients whose cancer therapies have failed but who show a good performance status. Our data require confirmation in a well-designed prospective clinical trial.

GBS antenatal screening and recto-vaginal colonization rates before and during the COVID-19 pandemic

Background: The SARS-CoV-2 pandemic has resulted in the implementation of recommendations to reduce interpersonal contact. From March 2020, rules were applied also in Italian Obstetrics units. Recent data report reduced rates of nosocomial and surgical site infections during the pandemic period. We wonder whether measures for containment of SARS-CoV-2 transmission would affect Group B streptococcus (GBS) maternal recto-vaginal colonization rates, usually screened at 36-37 weeks' gestation. The primary endpoint of this study was to evaluate the rate of maternal GBS colonization at antenatal screening. Method(s): This is a retrospective observational study (carried out in district of Modena), comparing maternal GBS colonization rates in the pre-COVID-19 (2018-2019) and during the pandemic period (2020-2021). Rates of rectovaginal colonization were retrieved from the laboratory database. The total number of deliveries was collected. Data were analyzed by using the Chi-Squared test, also evaluating the adherence to the GBS screening. A p-value < 0.05 was considered significant. Result(s): A total of 10968 and 10802 deliveries occurred in the pre-COVID-19 and the Pandemic period respectively (overall reduction in deliveries of 1.5%). The adherence to the antenatal GBS screening declined from 96.6% (pre-COVID-19 era) to 91.6% (pandemic era, p<0.001). Notably, the proportion of positive GBS screening remained stable (18.3% in 2018-2019 and 18.2% in 2020-2021, p=0.80). Conclusion(s): During the SARS-CoV-2 pandemic, we reported a reduced adherence to antenatal GBS screening. SARS-CoV-2 containment measures adopted by both the population and hospital professionals did not affect GBS colonization rates.

Stillbirths during SARS-CoV-2 virus pandemic: What has changed?

The coronavirus SARS-CoV-2 was identified as the causative agent for a series of atypical respiratory diseases in China in December 2019. This infection was officially declared a pandemic by the WHO on March 2020, and it has affected over 170 million people in the world. In Emilia-Romagna, there is a Surveillance System of stillbirth (SB) since 2014. It records and audits, in a multidisciplinary way, each single case reported by every birth centre of the Region. In this study, we compared SB information collected in the Surveillance System database in pandemic period (March to December 2020) with the ones in the same period, recorded in the previous 6 years. SB was defined according to WHO recommendation. The numbers of birth per years was obtained by Birth certificates (CedAP). During pandemic, there were 89 SB out of 25,225 births allowing a rate of 3.52/1000. For the same period, in the previous 6 years, SB rate ranged from 3.00 (83/27,625) in 2018 to 3.55 (91/26,493) in 2019. Overall, SB rate did not change. No cases of SB were detected in pregnant women affected by SARS-CoV-2 infection. Risk factors as maternal age, years of education, country of origin, gestational weight gain and smoking did not change, while an increased number of SB was recorded in multiparous women (OR 1.62, 95%IC 1.02-2.55) and in overweight ones (OR 1.64, 95%IC 1.03-2.62). Overall, the proportion of preterm births was not substantially different between pandemic period compared to the previous period (OR 1.34, IC95% 0.81-2.23). However, there was a significant increase of SB cases occurring at 22+0-24+6 weeks (OR 3.55, 95%IC 1.49-8.45). Moreover, we found almost double increase of small for gestational age (SGA) infants (OR 1.88, 95%IC 1.16-3.05) and SB related to multiple pregnancy (OR 2.15, 95%IC 1.01-4.56) in pandemic period. The multivariate analysis confirms a higher risk of SB in overweight mothers with SGA infants at 22+0-24+6 weeks during pandemic (respectively OR 1.65, 95%IC 1.01-2.69, OR 1.73, 95%IC 1.03-2.92, and OR 2.18, 95%IC 1.13-4.19) (Table 1). According to ReCoDe classification, there were not significant changes in the frequency of SB causes, compared to the previous period. However, there was a trend toward an increase of the placental abruption cases (17/89 vs 67/555: OR 1.72, 95%IC 0.96-3.09). The quality of pregnancy care was evaluated by using CESDI grade, where grades 2 and 3 refer to substandard care (2: different management might have made a difference to outcome;3: different management would have been reasonably expected to have made a difference to outcome). At audit, cases with grade 2 or 3 during pandemic was 6%, similar to the reference period (10%). No significantly changes occurred in the number of obstetric evaluations as well as in the number of ultrasounds exams. Globally, SARS-CoV-2 pandemic did not substantially influence SB incidence and pregnancy cares. The pandemic restrictions might have affected the access of women at risk to pregnancy services, especially in the first half of gestation, with subsequent low detection rate of SGA.