Impact of Covid-19 pandemic on neuro-oncology multidisciplinary tumor board in the pre-vaccine era: the Normandy experience.

INTRODUCTION: The COVID19 pandemic had a strong impact on the healthcare system, particularly in oncology. Brain tumor are usually revealed by acute and life threatening symptoms. We wanted to evaluate the possible consequences of the COVID19 pandemic in 2020 on the activity of neuro-oncology multidisciplinary tumor board in a Normandy region (France). METHODS: A descriptive, retrospective, multicenter study was conducted in the four referent centers (two universitary hospitals and two cancer centers). The main objective was to compare the average number of neuro-oncology patients presented per multidisciplinary tumor board per week between a pre-COVID19 reference period (period 1 from December 2018 to December 2019) and the pre-vaccination period (period 2 from December 2019 to November 2020). RESULTS: Across Normandy, 1540 cases were presented in neuro-oncology multidisciplinary tumor board in 2019 and 2020. No difference was observed between period 1 and 2: respectively 9.8 per week versus 10.7, P=0.36. The number of cases per week also did not significantly differ during the lockdown periods: 9.1/week versus 10.4 during the non-lockdown periods, P=0.26. The only difference observed was a higher proportion of tumor resection during the lockdown periods: 81.4% (n=79/174) versus 64.5% (n=408/1366), P=0.001. CONCLUSION: The pre-vaccination era of the COVID19 pandemic did not impact the activity of neuro-oncology multidisciplinary tumor board in the Normandy region. The possible consequences in terms of public health (excess mortality) due to this tumor location should now be investigated.

Comparison of Analgesic Efficacy in Attenuating Spontaneous Pain Behaviors in Rats (Rattus norvegicus)

Significant analgesic shortages and price increases have occurred since the COVID-19 pandemic, having direct implications on available treatment options thus impacting animal wellbeing, repeatability, and biomedical research. Traditionally, multimodal treatments (e.g., systemic with local analgesic) and opioids (e.g., buprenorphine) are recommended for mitigating major postoperative pain in rodents, although, in extenuating circumstances, other analgesics like nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., meloxicam) must be used instead. However, the analgesic efficiency in attenuating spontaneous pain behaviors across treatment options has not been extensively evaluated in the rat laparotomy pain model. Here, we investigated whether extended-release buprenorphine (XR) was more effective at mitigating spontaneous pain behaviors in postoperative rats compared to other analgesic regimens. We hypothesized that XR would have the greatest analgesic effects in minimizing spontaneous pain behaviors and male XR rats would maintain longer therapeutic concentrations than other experimental groups. Sprague-Dawley rats (male n = 33;female n = 40) were randomly assigned by sex to 1 of 6 experimental groups: XR (0.65 mg/kg), buprenorphine (0.01 mg/kg), meloxicam (2 mg/kg), meloxicam with local bupivacaine (2 mg/kg and < 2 mg/kg, respectively), saline (5 mL/kg), and unoperated control. After subcutaneous drug administration, a 3-cm midline incision was made, penetrating the peritoneal cavity under isoflurane anesthesia. Spontaneous pain behaviors were evaluated using a subjective pain score, the open field arena test, and the burrowing test at baseline, 2, 24, 48, 72, and 168 hr postlaparotomy. Clinical observations were recorded daily and a gross necropsy was performed. Blood was collected for pharmacokinetic analysis from a separate cohort receiving identical analgesic doses (male n = 17;female n = 23). All groups displayed spontaneous pain behaviors as measured 2 hr postlaparotomy despite preemptive analgesic treatment (P < 0.02) and having therapeutic drug plasma concentrations. This study provides support that a multidimensional approach is warranted when investigating the analgesic efficacy and suggests more sensitive, objective outcome measures of spontaneous pain are needed.

Decision physiotherapy workshop: Eric O. 55 years old. ICU with Covid-19

Eric O., 55 years old, is hospitalized in intensive care for a severe form of COVID-19. We retrace the evolution of this patient, whose life was put at stake on several occasions and who was finally transferred to a respiratory rehabilitation centre for further care. The key times of his care allow us to understand the physiotherapeutic actions that were put in place. Evidence index (EVID-i): 3.2.