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Introduction: Cancer cervix is the 2nd most common malignancy among Indian females with 1,23,907 new cases every year. Treatment options include radical radiotherapy wherein internal radiation plays an imperative role. Intracavitary applications in anatomically distorted uteri present a challenge and often result in sub-optimal applications. The purpose of this study is to determine the incidence of anatomically variable uterus in cancer cervix patients and the rate of intra-operative complications with Intracavitary brachytherapy (ICBT). Materials and methods: An audit of 276 biopsy-proven cancer cervix patients treated with ICBT between Jan 2019 to June 2022 was undertaken. FIGO stage I-IVA were included while metastatic and post-operative cases were excluded. All applications were done using the Modified Fletcher-Suit applicator, and planned on CT using Brachy vision 13.6.5, based on Point A. Results: 41/276 (14.9%) patients presented with anatomically variable uteri. 20/41 (48.78%) were retroverted uteri, 11/41 (26.82%) were anteflexed and 5 each (12.19%) had cervical stenosis and atrophied uteri respectively. The total number of applications performed was 120, and complications were recorded in 42 applications. There was a statistically significant correlation between the patient's age and the incidence of procedural complications, with an increased incidence of complications in the advanced age group (p-value -- 0.001). Similarly, a significant correlation was found between distorted anatomy and the incidence of complications (p-value -- 0.045). The higher rectal dose was observed in anteflexed uteri (p-value -- 0.001) while retroverted uteri was associated with a higher bladder dose (p-value -- 0.001). Conclusions: In anatomically difficult uteri, brachytherapy application is a challenge with significantly high rates of complications including perforation. Careful selection of tandem length and orientation of the uterine anatomy after the first fraction may enable better application in subsequent fractions. [ABSTRACT FROM AUTHOR]

Chronic complications are a significant concern for people living with HIV/AIDS (PLWHA) infection. HIV-associated neurocognitive disorders (HAND) are prevalent in PLWHA. Yet, the efficacy of medications that penetrate the central nervous system (CNS) at preventing or slowing the progression of HAND remains largely unknown. The objective of this study was to determine whether high CNS penetration effectiveness (CPE) regimens improve neurocognitive test scores in PLWHA on combined antiretroviral therapy (cART). Primary literature evaluating cognitive outcomes based on CPE score of cART regimens in PLWHA was assembled from PubMed/Medline and EMBASE. Both randomized controlled trials and observational studies with at least 12 weeks of follow-up were included. A meta-analysis was conducted to calculate the standardized mean difference. Eight trials including a total of 3,303 patients with 13,103 person-years of follow-up were included in the systematic review. Four trials (n = 366 patients) met our inclusion criteria and were included in the meta-analysis. In the meta-analysis, HIV regimens with a high CPE score did not affect NPZ-4 or GDS scores (standardized mean difference (SMD) 0.10, 95% CI −0.19, 0.38; I2 = 26%). Future studies with larger sample sizes are warranted to prospectively evaluate the relationship between CPE and progression of HAND. [ABSTRACT FROM AUTHOR]

Background A systematic review and meta-analysis of real-world observational studies was conducted to summarize the impact of letermovir cytomegalovirus (CMV) primary prophylaxis (PP) among adult allogeneic hematopoietic cell transplant (allo-HCT) recipients. Methods Systematic searches in Medline/PubMed, Embase, and conferences (from database inception to October 2021) were conducted to identify studies for inclusion. Random-effects models were used to derive pooled estimates on the relative effectiveness of letermovir PP compared to controls. Results Forty-eight unique studies (N = 7104 patients) were included, most of which were comparative, single-center, and conducted in the United States. Letermovir PP was associated with statistically significant reduction in odds of CMV reactivation (pooled odds ratio [pOR], 0.13 and 0.24; P <.05), clinically significant CMV infection (pOR, 0.09 and 0.19; P <.05), and CMV disease (pOR, 0.31 and 0.35; P <.05) by day +100 and day +200 after allo-HCT, respectively. Letermovir PP was associated with significantly lower odds of all-cause (pOR, 0.73; P <.01) and nonrelapse mortality (pOR, 0.65; P =.01) beyond day 200 after allo-HCT. Conclusions Letermovir for CMV PP was effective in reducing the risk of CMV-related complications overall and mortality beyond day 200 among adult allo-HCT recipients. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to examine treatment-related adverse events (TRAEs) for combination of nivolumab (NIVO) and ipilimumab (IPI) compared to NIVO monotherapy among cancer patients. We searched several databases to identify relevant RCTs. Meta-analysis was performed using random-effects model. In fourteen RCTs included in the study, we found that compared to NIVO monotherapy, combination NIVO + IPI increased the risk of any grade (Risk Ratio (RR) = 1.11), and grade 3 or 4 (RR = 1.95) TRAEs. Compared to NIVO, NIVO + IPI had higher risk for any grade colitis (RR = 4.52), pneumonitis (RR = 3.06), and diarrhea (RR = 1.68). [ABSTRACT FROM AUTHOR]