A brief review of the monkeypox virus and emerging concerns for neuroinvasiveness.

Background: Amidst the ongoing COVID-19 pandemic, monkeypox virus (MPXV) disease has been recognized as another disease of pandemic nature by the World Health Organization. Nearly four decades after the eradication of smallpox, as half of the world population is naïve to ortho-pox viruses (supposedly due to lack of immunity by vaccination), MPXV remains the most pathogenic species of the family of poxviruses. Methods: The articles on MPXV were searched on PubMed/Medline and data were retrieved and analyzed. Results: Although reported as a disease of milder exanthem and lower mortality as compared to smallpox, the MPXV disease tends to be neuroinvasive. This article highlights the neurological signs and symptoms of MPXV disease and discusses, in brief, the management strategies. Conclusion: Neuroinvasive properties of the virus as demonstrated in in vitro studies, and further verified by neurological illnesses in patients, present a special threat to mankind. Clinicians must be prepared to recognize and treat these neurological complications and start treatment to limit long-lasting brain injury as seen in patients with COVID-19.

COVID-19-induced atypical pneumonia in an unseparated adult conjoined twin in a remote setup of developing country: management by telemedicine. Illustrative case.

BACKGROUND: Telemedicine is the use of wireless communications and Web-based technologies to provide healthcare and services. The coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to healthcare providers, who have been forced to change their usual mode of service delivery and have been given an opportunity to adopt the concept of telemedicine. OBSERVATIONS: A 40-year-old underprivileged and unseparated conjoined twin (pygopagus) had dorsal spine tuberculosis and was on a regular follow-up through telemedicine due to the ongoing COVID-19 pandemic and embarrassment they had to face in public appearances. After a few months, they contracted COVID-19 infection after which they were shifted to our tertiary care center. Several unique challenges were encountered during the 4-day course of management. Ultimately, they died and left us with questions of whether we are really prepared to tackle these challenges. LESSONS: The general public should be made aware of such groups of patients and to encourage them to follow COVID-appropriate behavior. Vaccinations should be given on a priority basis to these subsets. A more robust approach of telemedicine consultation is required for management of patients in remote areas at the time of a pandemic. Ventilator management of these patients is still intriguing.

Surgical management of post-COVID invasive rhino-orbito-cerebral mucormycosis and its outcomes: Role of neurosurgeons in a tertiary care center.

Background: Mucormycosis, which was previously considered to be rare, has emerged with a new challenge in patients infected with or recovering from COVID-19. Immunocompromised patients are particularly prone to developing this disease. The most common form of presentation is rhino-orbito-cerebral mucormycosis (ROCM). We present various neurosurgical approaches to an entire spectrum of its clinical manifestations. Methods: This is a retrospective study of patients who were admitted to the neurosurgery department with ROCM and a history of COVID-19 infection between November 1, 2020, and September 1, 2021. All cases of ROCM underwent contrast-enhanced computed tomography/magnetic resonance imaging of the brain, paranasal sinuses, and orbit. A tissue biopsy was sent for histopathological analysis. All confirmed cases received liposomal amphotericin B and surgical treatment was immediately undertaken. Results: Out of 200 patients with ROCM, 40 patients presented with neurological manifestations. Seven out of 40 patients had focal lesions in the brain and skull bone that needed neurosurgical intervention along with sinus debridement and antifungal treatment. These seven patients presented with different clinical manifestations: large-vessel stroke (one), medium-vessel stroke (one), frontal lobe abscess (one), frontal bone osteomyelitis (two), isolated central nervous system involvement (one), and mucor mimicking trigeminal schwannoma (one). The surgical intervention included decompressive craniectomy, frontal craniotomy, subtemporal craniotomy, and a minimally invasive supraorbital keyhole approach. Conclusion: In high-risk patients, a high level of clinical suspicion combined with appropriate investigations should be performed as soon as possible. Symptoms and early warning signs should not be overlooked, as treatment delays can be fatal. A minimally invasive surgical approach is possible in view of decreasing the morbidity of large craniotomy.

Modification of neurosurgical practice during corona pandemic: Our experience at AIIMS patna and long term guidelines.

BACKGROUND: First case of covid-19 was confirmed on 30th January 2020 in India. Our state, Bihar reported its first confirmed case of covid on 22nd march 2020 at AIIMS Patna. For safety, Electives surgeries and outpatient department was suspended temporary since 25th March. Standard operating procedure (SOP) was framed for covid suspected, covid positive and negative patients. Neurosurgery department formulated their own strategy for successful and covid free management of neurosurgical patients along with zero transmission rate among doctors and staff. METHODS: All Neurosurgical patients who got attended, admitted and operated from 25th March to 30th June 2020 (Period of lockdown) were taken in this study. Categorizations of the patients were done according to the urgency and elective nature of pathology after corona screening and RT-PCR testing of covid-19. A proper training to all neurosurgical staff and residents were given for management of patients (admission to operation to discharge). RESULTS: Total 133 patients were attended and 90 were admitted. We operated 76 cases (major - 52, minor - 24) during the lockdown period. Out of this 2 were corona positive (both eventually succumbed) and rest 74 was corona negative. One patient who was operated with corona negative report became positive after 10 days of surgery inward. All the residents, faculty and nursing staff remain asymptomatic throughout the lockdown period with zero infection rate and zero transmission rate. CONCLUSION: Following a properly made standard operating procedure and strictly implementing it can avoid any type of misadventure in neurosurgery during corona pandemic.