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.

Peculiarities of Atypical Meningiomas: Literature Review / Peculiaridades dos meningiomas atípicos: Revisão da literatura

Introduction Meningiomas are common tumors of the central nervous system that represent around 30% of primary tumors. However, the incidence of atypical meningiomas (AMs) is lower, of approximately 15% of all meningiomas, and they present high rates of relapse and mortality. Aim To review peculiarities of AMs. Methodology A literature review of articles published in English between 2009 and 2020 on the PubMed and Biblioteca Virtual em Saúde (BVS) databases using the terms meningioma and atypical. Results Atypical meningiomas are rare and more prevalent in older males. The clinical condition depends on the site of the tumor, and a definitive diagnosis of AM is only possible via anatomical pathology. Moreover, prominent studies have indicated a relationship between the presence of the anti-Ki67 antibody/mindbomb (Ki -67/MIB1) marker as an aid in the definition of AM and one of the determinants of tumor aggressiveness. Imaging studies have also advanced in terms of seeking criteria using magnetic resonance that may suggest the malignancy of a lesion. As far as treatment is concerned, total resection remains the main therapeutic option, and it has a direct relationship with survival and time until disease progression. Lastly, there are many factors involved in the prognosis of AM. Conclusion Atypical meningiomas continue to be a challenge, requiring further and more specific studies to provide a better understanding of it.

Introdução Os meningiomas são tumores comuns do sistema nervoso central, representando cerca de 30% dos tumores primários. Contudo, a incidência de meningiomas atípicos (MA) é menor, cerca de 15% do total dos meningiomas, e eles apresentam altas taxas de recidiva e mortalidade. Metodologia Revisão da literatura, nas bases de dados PubMed e Biblioteca Virtual em Saúde (BVS), utilizando os termos "meningioma" e "atypical", publicados em língua inglesa entre 2009 e 2020. Objetivo Revisar as particularidades dos MA. Resultados MA são raros, mais prevalentes em homens de idade avançada. O quadro clínico depende da localização do tumor e o diagnóstico definitivo de MA só se dá por meio do anatomopatológico. Ademais, estudos importantes têm apontado para a relação da presença do marcador anticorpo monoclonal/mindbomb (Ki-67/MIB1) como auxiliador na definição de MA e um dos determinantes de agressividade tumoral. Os estudos de imagem também avançam no sentido de buscar critérios na ressonância magnética que possam sugerir a malignidade de uma lesão. Em relação ao tratamento, a cirurgia de ressecção total se mantém como principal terapêutica, com relação direta na sobrevida e no tempo livre de progressão de doença. Por fim, o prognóstico em MA é multifatorial. Conclusão MA continuam como um desafio, necessitando de mais estudos específicos para compreendê-los melhor.