RESUMEN
The entire world including India is currently fighting the coronavirus disease 19 (COVID-19) pandemic that threatens to disrupt healthcare systems globally in terms of capacity and resources. This outbreak necessitates an urgent review of existing management guidelines for commonly encountered tumors of the brain and central nervous system (CNS). Such a review should include a reassessment of benefit-risk ratio to align with local, national, and international priorities without compromising on delivery of care in terms of safety, compassion, efficiency, and effectiveness. Towards this end, the Indian Society of Neuro-Oncology (ISNO) constituted an online expert panel with adequate representation from all major treatment modalities (neuro-surgery, radiation oncology, and pediatric/medical oncology) to formulate a "COVID-19 context" position statement to guide the care of neuro-oncology patients during the ongoing crisis. The ISNO position statement suggests graded prioritization (based on clinical presentation, type of tumor, expected prognosis, and relevance of immediate therapy) for efficient utilization of resources and provides a framework through a set of general considerations, treatment modality-based considerations, and disease-specific considerations for the guidance of healthcare professionals involved in the delivery of care and services to patients with CNS tumors. The views expressed herein represent the current consensus of key opinion leaders from within the Indian neuro-oncology community and should not be in any case considered binding medically or legally to individual physicians and/or hospitals who may formulate their guidelines based on local setup and health-environment and update them periodically based on emerging evidence through the COVID-19 pandemic.
Asunto(s)
Betacoronavirus/patogenicidad , Neoplasias del Sistema Nervioso Central/terapia , Infecciones por Coronavirus/complicaciones , Oncología Médica/normas , Neumonía Viral/complicaciones , COVID-19 , Consenso , Humanos , India , Pandemias , SARS-CoV-2Asunto(s)
Epilepsia , Malformaciones del Desarrollo Cortical , Humanos , Calidad de Vida , ConvulsionesRESUMEN
Traumatic brain injury (TBI) related impact results in a permanent need for help in performing daily activities. Standard treatment consists of removing the cause, restore perfusion, support metabolic requirement and limit inflammatory and oxidative damage. Hyperbaric oxygen therapy (HBOT) is one such newer promising treatment that enhances neurological recovery to some extent. HBOT is intermittent inhalation of 100% oxygen at greater than normal atmospheric pressure and is internationally accepted for its role in well-defined indications. It is hypothesised that HBO has a role in reviving 'idling neurons', also called the ischemic penumbra defined as area of reduced cerebral blood flow, abolished synaptic activity but preserved structural integrity. We carried out a retrospective analysis of medical records of 20 patients of TBI who had been treated with HBOT in addition to standard management. These were placed in Group A (test group) and received at least 30 sessions of HBO along with standard treatment. The patients were assessed along the Disability Rating Scale (DRS), Glasgow coma scale (GCS) and Rancho Los Amigos Scale (RLAS). Another 20 patients of TBI, matched in age and severity of brain injury, who received standard treatment but not HBOT, were selected as the control group (Group B). Assessment on the DRS showed maximum improvement in patients with scores of 22-24 (vegetative state).The percentage of patients in the test group fell from 45% to 5% whereas only 20% patients in Group B had similar progress. After the treatment, a significantly higher proportion of HBOT treated subjects showed a good response in cognitive functions, as measured by RLA. In group A, 90% patients had a score of ≤ 3 and in Group B 95% had a similar score, which improved to ≥ 3 in 60% patients versus 30% patients respectively. In both groups maximum patients are in 1-6 months post-injury category and within the groups this category showed the greatest recovery, with a greater improvement in the test group as compared to control group.