Effect of hyaluronic acid on radiotherapy-induced mucocutaneous side effects: a meta-analysis of randomized controlled trials.

PURPOSE: Radiotherapy (RT)-induced mucocutaneous side effects remain a clinical challenge in cancer patients. Hyaluronic acid (HA), a key molecule in tissue regeneration, may relieve these side effects. The aim of the study is to investigate the effects of HA on RT-induced side effects in patients with cancer. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out. PubMed, Embase, and Cochrane Library were searched for published studies. A meta-analysis was conducted to calculate the pooled effect size using a random-effect model. RESULTS: Fifteen trials with 1131 patients were included. The HA group demonstrated a significant improvement in skin pain scores (mean difference [MD]: - 1.14, 95% confidence interval [CI]: - 2.21 to - 0.08) at week 4, and significantly decreased pain frequency (risk ratio [RR]: 0.47, 95% CI: 0.24 to 0.93) at 5 to 8 weeks when compared with the control group. The HA group also exhibited a significantly lower incidence of desquamation (RR: 0.27, 95% CI: 0.15 to 0.5) at 4 to 5 weeks and the most severe mucosal problems (RR: 0.14, 95% CI: 0.04 to 0.45) compared with the control group. Moreover, the HA group had a significantly lower incidence of bleeding (RR: 0.18, 95% CI: 0.05 to 0.65) than the control group at 4 months and 18 months. CONCLUSION: HA treatment may reduce RT-induced mucosal problems and pain. Moreover, HA is safe and has the potential for application in diverse forms and textures for pharmacotherapeutic use. Additional trials involving a higher number of patients are recommended.

The global response: How cities and provinces around the globe tackled Covid-19 outbreaks in 2021.

Background: Tackling the spread of COVID-19 remains a crucial part of ending the pandemic. Its highly contagious nature and constant evolution coupled with a relative lack of immunity make the virus difficult to control. For this, various strategies have been proposed and adopted including limiting contact, social isolation, vaccination, contact tracing, etc. However, given the heterogeneity in the enforcement of these strategies and constant fluctuations in the strictness levels of these strategies, it becomes challenging to assess the true impact of these strategies in controlling the spread of COVID-19. Methods: In the present study, we evaluated various transmission control measures that were imposed in 10 global urban cities and provinces in 2021- Bangkok, Gauteng, Ho Chi Minh City, Jakarta, London, Manila City, New Delhi, New York City, Singapore, and Tokyo. Findings: Based on our analysis, we herein propose the population-level Swiss cheese model for the failures and pitfalls in various strategies that each of these cities and provinces had. Furthermore, whilst all the evaluated cities and provinces took a different personalized approach to managing the pandemic, what remained common was dynamic enforcement and monitoring of breaches of each barrier of protection. The measures taken to reinforce the barriers were adjusted continuously based on the evolving epidemiological situation. Interpretation: How an individual city or province handled the pandemic profoundly affected and determined how the entire country handled the pandemic since the chain of transmission needs to be broken at the very grassroot level to achieve nationwide control. Funding: The present study did not receive any external funding.