The impact of coronavirus 2019 (COVID-19) on neurosurgical practice and training: a review article.

The 2019 coronavirus pandemic (COVID-19) has affected all of society at different levels. Similarly, COVID-19 has significantly impacted every medical field, including neurosurgery. By exposing scarcities in the healthcare industry and requiring the reallocation of available resources towards the priority setting and away from elective surgeries and outpatient visits, the pandemic posed new, unprecedented challenges to the medical community. Despite the redistribution of resources towards COVID-19 patients and away from elective surgeries, urgent and emergent surgeries for life-threatening conditions needed to be continued. The neurosurgical community, like other specialties not directly involved in the care of COVID-19 patients, initially struggled to balance the needs of COVID-19 patients with those of neurosurgical patients, residents, and researchers. Several articles describing the effect of COVID-19 on neurosurgical practice and training have been published throughout the COVID-19 pandemic. This article aims to provide a focused review of the impact COVID-19 has had on neurosurgical practice and training as well as describe neurological manifestations of the disease.

Coronavirus disease 2019 (COVID-19) can predispose young to Intracerebral hemorrhage: a retrospective observational study.

BACKGROUND: The respiratory system involvement is the most common presentation of Coronavirus disease 2019 (COVID-19). However, other organs including the central nervous system (CNS) could be affected by the virus. Strokes, seizures, change in mental status, and encephalitis have been reported as the neurological manifestation of the disease. We hypothesized that COVID-19 could predispose younger patients to spontaneous intracerebral hemorrhage (ICH). The present study aimed to investigate whether COVID-19 has any relationship with the occurrence of spontaneous ICH in young or not. METHODS: We retrospectively evaluated all the patients with spontaneous ICH who were referred to our center between 20 Feb and 1 Sep 2020. The demographic, clinical, radiological, and laboratory test data were evaluated. Patients were divided into two groups. The COVID-19 positive patients and COVID-19 negative ones. All the variables including age, sex, history of hypertension, diabetes mellitus, smoking, Glasgow Coma Scale (GCS), hematoma volume and location, the presence of intraventricular hemorrhage and hydrocephalus on admission, the length of hospital stay, the lab test results and the clinical outcome at last visit or discharge as Glasgow Outcome Scale (GOS) were compared between the two groups. RESULTS: There were 22 COVID-19 positive patients (20.8%) and 84 COVID-19 negative ones (79.2%). The mean age of the patients in the case group (54.27 ± 4.67) was significantly lower than that in the control group (69.88 ± 4.47) (p < 0.05). Meanwhile, our results showed a significant difference between the two groups based on the presence of chronic arterial hypertension (p < 0.05). There were no significant differences between the two groups based on gender, diabetes mellitus, smoking, Glasgow Coma Scale (GCS), hematoma volume, need for surgery, the presence of intraventricular hemorrhage and hydrocephalus on admission, White Blood Cell (WBC) count, platelet count, Prothrombin Time (PT), and Partial Thromboplastin Time (PTT) (p > 0.05). CONCLUSIONS: Our results show that COVID positive patients with ICH are younger and with less predisposing factors than COVID negative subjects with ICH.

Preoperative platelet distribution width-to-platelet count ratio as a prognostic factor in patients with glioblastoma multiforme.

BACKGROUNDS: The prognostic significance of the platelet volume indices (PVIs), including the platelet distribution width (PDW), mean platelet volume (MPV), and platelet distribution width-to-platelet count ratio (PDW/P) has been demonstrated in a variety of malignancies. This study aimed to evaluate the prognostic value of PVIs in patients with a newly diagnosed glioblastoma multiforme (GBM). METHODS: We retrospectively evaluated the clinical data of 143 patients with GBM who managed at our center between May 2010 and May 2019. Receiver operating characteristic curves (ROC) for cutoff value determination, Kaplan-Meier survival analysis, and univariate and multivariate Cox regression analyses were performed. RESULTS: The corresponding cutoff values for MPV, PDW, and PDW/P were 9.05, 14.7, and 0.51, respectively. The Kaplan-Meier survival analyses showed that patients with an MPV < 9.05 and those with PDW <14.7 and cases with PDW/p < 0.51 had a longer overall survival (OS) (p < 0.05). Based on univariate analysis, age, Karnofsky Performance Status scores (KPS), tumor focality, MPV, PDW, and PDW/P were predictors of OS (p < 0.05). Final multivariate Cox regression analyses showed age (HR 1.040, 95% CI 1.009-1.071, P,0.011), KPS (HR 2.208, 95% CI 1.107-4.405, P,0.025), tumor focality (HR 4.596, 95% CI 1.988-10.626, p < 0.001), and PDW/P (HR 1.786, 95% CI 1.103-3.072, P,0.037) as the independent predictors of OS in patients with newly diagnosed glioblastoma. CONCLUSIONS: Our results suggest an elevated preoperative PDW/P, along with previously established variables, as a simple and inexpensive prognostic factor for patients with GBM.

Clinical effectiveness and safety of fingolimod in relapsing remitting multiple sclerosis in Western Iran.

OBJECTIVE: To investigate the clinical effectiveness and safety of fingolimod in the western Iranian population. METHODS: This study was performed as a prospective observational study between March 2014 and October 2015. Sixty patients with relapsing remitting multiple sclerosis (RRMS) who were referred to the MS clinic of Imam Reza Hospital, which is affiliated with Kermanshah University of Medical Sciences, Iran, were treated with 0.5 mg oral fingolimod capsules once daily for 12 months. The outcomes were clinical and included the annualized relapse rate, expanded disability status scale (EDSS) change, proportion of relapse-free patient, and side effects. RESULTS: An 85% reduction in the annualized relapse rate compared with the baseline (from 1.8+/-1.35 to 0.27+/-0.58, p=0.001) was observed, and 76.66% of patients were free from relapse after the 12-month intervention. In addition, a significant reduction of EDSS was measured from 3.32 at baseline to 2.97 (p=0.001). The overall adverse events in our study were similar to those in previous studies. CONCLUSION: The present study confirms the effectiveness of fingolimod as a second-line therapy in western Iranian RRMS patients. Fingolimod side effects were generally mild and tolerable.

Evaluation of pulsing magnetic field effects on paresthesia in multiple sclerosis patients, a randomized, double-blind, parallel-group clinical trial.

OBJECTIVES: Evidence is mounting that magnet therapy could alleviate the symptoms of multiple sclerosis (MS). This study was performed to test the effects of the pulsing magnetic fields on the paresthesia in MS patients. PATIENTS AND METHODS: This study has been conducted as a randomized, double-blind, parallel-group clinical trial during the April 2012 to October 2013. The subjects were selected among patients referred to MS clinic of Imam Reza Hospital; affiliated to Kermanshah University of Medical Sciences, Iran. Sixty three patients with MS were included in the study and randomly were divided into two groups, 35 patients were exposed to a magnetic pulsing field of 4mT intensity and 15-Hz frequency sinusoidal wave for 20min per session 2 times per week over a period of 2 months involving 16 sessions and 28 patients was exposed to a magnetically inactive field (placebo) for 20min per session 2 times per week over a period of 2 months involving 16 sessions. The severity of paresthesia was measured by the numerical rating scale (NRS) at 30, 60days. The study primary end point was NRS change between baseline and 60days. The secondary outcome was NRS change between baseline and 30days. RESULTS: Patients exposing to magnetic field showed significant paresthesia improvement compared with the group of patients exposing to placebo. CONCLUSION: According to our results pulsed magnetic therapy could alleviate paresthesia in MS patients .But trials with more patients and longer duration are mandatory to describe long-term effects.

The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis.

OBJECTIVE: To compare the efficacy and safety of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) in the treatment of patients with cerebral venous sinus thrombosis (CVST), and to provide an appropriate treatment option in these patients. METHODS: This is a randomized double blind clinical trial conducted between December 2013 and December 2014. The subjects were selected among patients referred to Neurology Department, Imam Reza Hospital; affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran. Fifty-two cases of CVST were included in this study and randomly divided into 2 groups. Twenty-six cases received LMWH and the other 26 cases received UFH. The primary outcomes include hospital mortality rate and neurologic deficits as assessed by the National Institutes of Health Stroke Scale (NIHSS). The secondary end point was disability as measured by the Modified Rankin Scale (MRS). RESULTS: We observed the rate of mortality and neurological deficits and disability based on NIHSS, and the MRS did not differ between the 2 groups. CONCLUSION: The efficacy of LMWH and UFH in reduction of neurologic deficit and functional disability in patients with CVST are similar.

Evaluation of the efficacy and safety of pregabalin, venlafaxine, and carbamazepine in patients with painful diabetic peripheral neuropathy. A randomized, double-blind trial.

OBJECTIVE: To evaluate the efficacy and safety of carbamazepine, pregabalin, and venlafaxine in patients with painful diabetic neuropathy (PDN). METHODS: Our study was performed as a randomized, double-blind, parallel-group clinical trial between December 2012 and December 2013 at Kermanshah University of Medical Sciences, Kermanshah, Iran. Two hundred and fifty-seven patients with clinically definite PDN were randomized to receive, carbamazepine, venlafaxine, or pregabalin. The primary outcome was subjective pain as assessed by the visual analogue scale (VAS). Secondary outcomes consisted of sleep, mood, and work interference assessments, and a percentage of patients achieving at least 50% reduction in pain intensity. RESULTS: Means of VAS scores for carbamazepine, pregabalin, and venlafaxine treatment groups at the baseline (74.5, 82.3, and 74.5) and endpoint (39.6, 33.4, and 46.6) revealed significant reduction, although pregabalin was more efficacious than carbamazepine, and venlafaxine. Improvements in means scores of sleep, mood, and work interferences were identified in all treatment groups. CONCLUSION: This study showed the efficacy of venlafaxine, pregabalin, and carbamazepine in pain reduction in patients with diabetic neuropathy, although pregabalin was shown to be superior to carbamazepine, and venlafaxine in relieving pain, no significant superiority was shown between carbamazepine, and venlafaxine.

Study of fatigue frequency and its association with sociodemographic and clinical variables in patients with multiple sclerosis.

OBJECTIVE: To evaluate the frequency of fatigue and its association with demographic variables and disease specific variables in multiple sclerosis (MS) patients. METHODS: In this study, 300 patients (72% female, 28% male) with clinically definite MS admitted to the outpatient MS clinic of Imam Reza Hospital, affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran, were evaluated between November 2011 and September 2012. Their demographic and clinical characteristics were recorded on standardized forms. Fatigue was assessed using the fatigue severity scale. RESULTS: The frequency of fatigue was 62.3%, the mean age of patients was 35.26+/-8.7 SD. The mean age of fatigued patients was 36.51+/-8.65 SD. Fatigue was found in 100% of progressive forms of disease, and 54.8% of relapsing-remitting MS patients. CONCLUSION: Fatigue was a frequent sign in studied MS patients, and was associated with type of disease, interferon, gender, and duration of disease. There was no association between fatigue and age, education, and marital state. It is important to pay more attention to fatigue in MS patients, and use quantitative tools for its assessment.

P wave duration and dispersion and QT interval in multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is one of the most frequent disorders of central nervous system, resulting in autonomic disturbances. Some electrocardiographic changes have been reported in these patients that can lead to arrhythmia. In this study we compared P wave duration and dispersion and QT interval of MS patients to healthy control subjects. MATERIAL AND METHODS: Eighty four multiple sclerosis patients and 84 healthy, age and sex-matched volunteers were included. A 12-lead electrocardiogram was undertaken in order to measure minimal and maximal P wave duration, P wave dispersion (PWD) and QT interval. RESULTS: In patient group, mean P wave duration, maximum P wave duration and PWD were significantly longer than control group. QT interval was longer in patient group but the difference was not significant. CONCLUSION: In this study, P wave duration and P wave dispersion was found to be higher in MS patients than healthy control subjects.

The effects of cinnarizine versus sodium valproate in migraine prophylaxis.

AIM: The aim of this randomized, double-blind, parallel-group study was to compare the efficacy and safety of low-dose cinnarizine and sodium valproate in migraine prophylaxis. METHODS: A total of 104 patients were treated during a 12-week treatment period. Cinnarizine dose of 25 mg and 200-mg sodium valproate were administered every 12 hours. During follow-up period, frequency, intensity and duration of migraine attacks, symptoms associated with headache, analgesics use, as well as drugs' side effects were studied. Participants completed Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) questionnaires before and after treatment. RESULTS: Frequency, intensity and duration of migraine headaches as well as MIDAS score and administration of symptomatic medications decreased significantly between repeated follow-up visits in both groups. Reduction of 4-week migraine frequencies in patients receiving cinnarizine and valproate was 36.4% and 55%, respectively, and the difference between two groups was statistically significant (p < 0.001). CONCLUSION: Our results showed that administration of 25-mg cinnarizine every 12 hours can significantly decrease headache duration (p ≤ 0.001) and headache frequency (p ≤ 0.001) in patients with migraine. These results suggest that cinnarizine may be an appropriate substitution for first-line migraine prophylaxis such as valproate.