Chemosensory Dysfunction 3-Months After COVID-19, Medications and Factors Associated with Complete Recovery.

OBJECTIVES: To examine the longitudinal prevalence and recovery of olfactory, gustatory, and oral chemesthetic deficits in a sizable cohort of SARS-CoV-2 infected persons using quantitative testing. To determine whether demographic and clinical factors, mainly the medications used after the COVID-19 diagnosis, influence the test measures. METHODS: Prospective cohort in a hospital with primary, secondary, tertiary, and quaternary care. Patients with confirmed COVID-19 were tested during the acute infection phase (within 15 days of initial symptom, n = 187) and one (n = 113) and 3 months later (n = 73). The University of Pennsylvania Smell Identification Test, the Global Gustatory Test, and a novel test for chemesthesis were administered at all visits. RESULTS: During the acute phase, 93% were anosmic or microsmic and 29.4% were hypogeusic. No one was ageusic. A deficit in oral chemesthesis was present in 13.4%. By 3 months, taste and chemesthesis had largely recovered, however, some degree of olfactory dysfunction remained in 54.8%. Remarkably, patients who had been treated with anticoagulants tended to have more olfactory improvement. Recovery was greater in men than in women, but was unrelated to disease severity, smoking behavior, or the use of various medications prior to, or during, COVID-19 infection. CONCLUSIONS: When using quantitative testing, olfactory disturbances were found in nearly all SARS-CoV-2 infected patients during the acute infection phase. Taste or chemesthetic deficits were low. Olfactory impairment persisted to some degree in over half of the patients at the 3-month follow-up evaluation, being more common in women and less common in those who had been treated earlier with anticoagulants. LEVEL OF EVIDENCE: 3.

Literature Review: Role of Neurosurgery in Leptomeningeal Carcinomatosis / Crítica literária: Papel da neurocirurgia na Carcinomatose Leptomeníngea

Introduction Leptomeningeal carcinomatosis results from metastatic neoplastic cells that reach the leptomeninges through the cerebrospinal fluid. The presentation of the disease is variable, making prognosis challenging. However, the presence of intracranial hypertension is common, which has prompted new treatments to mitigate this effect. Objective To report the role of neurosurgery in the treatment of leptomeningeal carcinomatosis, as well as its advances. Methodology Literature review with a search of the PubMed database, between 2011 and 2021, using the following descriptors: Neurosurgery, Leptomeningeal Carcinomatosis, Cerebrospinal and Treatment. A total of 42 articles were found, 16 of which were selected. Results The shunt insertion considerably improved the effects of cranial hypertension, increasing the average survival time of patients by 3.5 months after surgery. The Ommaya reservoir is also a viable option due to its convenience and safety. The V-Port, on the other hand, has overcome the challenges of conventional devices, with shorter operating times (42 minutes), smaller skin incisions, and no reports of postoperative infection. Conclusion Devices for the treatment of leptomeningeal carcinomatosis have been steadily improving, simplifying surgical procedures and benefiting patients.

Introdução A carcinomatose leptomeníngea resulta de células neoplásicas metastáticas que atingem as leptomeninges através do líquido cefalorraquidiano. A apresentação da doença é variável, tornando o prognóstico desafiador. No entanto, a presença de hipertensão intracraniana é comum, o que levou a novos tratamentos para mitigar esse efeito. Objetivo Relatar o papel da neurocirurgia no tratamento da carcinomatose leptomeníngea, bem como seus avanços. Metodologia Crítica literária com busca na base de dados PubMed, entre 2011 e 2021, utilizando os seguintes descritores: Neurocirurgia, Carcinomatose Leptomeníngea, Cefalorraquidiana e Tratamento. Foram encontrados 42 artigos, dos quais 16 foram selecionados. Resultados A inserção do shunt melhorou consideravelmente os efeitos da hipertensão craniana, aumentando o tempo médio de sobrevida dos pacientes em 3,5 meses após a cirurgia. O reservatório de Ommaya também é uma opção viável devido à sua conveniência e segurança. O V-Port, por outro lado, superou os desafios dos dispositivos convencionais, com tempos de operação mais curtos (42 minutos), incisões cutâneas menores e sem relatos de infecção pós-operatória. Conclusão Os dispositivos para o tratamento da carcinomatose leptomeníngea vêm melhorando constantemente, simplificando os procedimentos cirúrgicos e beneficiando os pacientes.