Predicting response to chemotherapy in brain tumor patients based on MRI features.

Chemotherapy in brain tumors is tailored based on tumor type, grade, and molecular markers, which are crucial for predicting responses and survival outcomes. This review summarizes the role of chemotherapy in gliomas, glioneuronal and neuronal tumors, ependymomas, choroid plexus tumors, medulloblastomas, and meningiomas, discussing standard treatment protocols and recent developments in targeted therapies.Furthermore, the studies reporting the integration of MRI-based radiomics and deep learning models for predicting treatment outcomes are reviewed. Advances in MRI-based radiomics and deep learning models have significantly enhanced the prediction of chemotherapeutic benefits, survival prediction following chemotherapy, and differentiating tumor progression with psuedoprogression. These non-invasive techniques offer valuable insights into tumor characteristics and treatment responses, facilitating personalized therapeutic strategies. Further research is warranted to refine these models and expand their applicability across different brain tumor types.

Feasibility of awake craniotomy for brain arteriovenous malformations: A scoping review.

Background: Brain Arteriovenous Malformations (AVMs) located in proximity to eloquent brain regions are associated with poor surgical outcomes, which may be due to higher rates of postoperative neurological deterioration. Current treatment protocols include stereotactic radiosurgery, transarterial embolization, and surgical resection under general anesthesia. Awake Craniotomy (AC) allows intraoperative mapping of eloquent areas to improve post-operative neurologic outcomes. Objectives: We reviewed the current literature reporting surgical outcomes and assessed the feasibility of AC for AVM resection. Methods: The PRISMA guidelines were utilized as a template for the review. Three databases including PubMed, Scopus, and Cochrane Library were searched using a predefined search strategy. After removing duplicates and screening, full texts were analyzed. Outcomes including the extent of resection, intra-operative and post-operative complications, and long-term neurologic outcomes were assessed. Results: 12 studies were included with a total of 122 AVM cases. Spetzler-Martin grading was used for the classification of the AVMs. The asleep-awake-asleep protocol was most commonly used for AC. Complete resection was achieved in all cases except 5. Intraoperative complications included seizures (n = 2) and bleeding (n = 4). Short-term post-operative complications included hemorrhage (n = 3), neurologic dysfunctions including paresis (n = 3), hemiplegia (n = 10), dysphasia/aphasia (n = 6), cranial nerve dysfunction (n = 3), and pulmonary embolism (n = 1). Almost all neurological deficits after surgery gradually improved on subsequent follow-ups. Conclusion: AVMs may shift the anatomical location of eloquent brain areas which may be mapped during AC. All studies recommended AC for the resection of AVMs in close proximity to eloquent areas as mapping during AC identifies the eloquent cortex thus promoting careful tissue handling which may preserve neurologic function and/or predict the postoperative functional status of the patients We, therefore, conclude that AC is a viable modality for AVMs resection near eloquent language and motor areas.

Intraoperative mapping and preservation of executive functions in awake craniotomy: a systematic review.

Awake craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial assessment, and motor functions are mapped, while the assessment of executive functions (EF) is uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus, a compromised quality of life. A comprehensive literature search was conducted through Scopus, Medline, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicate removal, initial screening, and full-text assessment. The demographic details, ioBM techniques, intraoperative tasks, and their assessments, the extent of resection (EOR), post-op EF and neurocognitive status, and feasibility and potential adverse effects of the procedure were reviewed. The correlations of tumor locations with intraoperative EF deficits were also assessed. A total of 13 studies with intraoperative EF assessment of 351 patients were reviewed. Awake-asleep-awake protocol was most commonly used. Most studies performed ioBM using bipolar stimulation, with a frequency of 60 Hz, pulse durations ranging 1-2 ms, and intensity ranging 2-6 mA. Cognitive function was monitored with the Stroop task, spatial-2-back test, line-bisection test, trail-making-task, and digit-span tests. All studies reported similar or better EOR in patients with ioBM for EF. When comparing the neuropsychological outcomes of patients with ioBM of EF to those without it, all studies reported significantly better EF preservation in ioBM groups. Most authors reported EF mapping as a feasible tool to obtain satisfactory outcomes. Adverse effects included intraoperative seizures which were easily controlled. AC with ioBM of EF is a safe, effective, and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.

Outcomes and Factors Affecting Transcranial Direct Current Stimulation in Alzheimer's Disease Patients: A Systematic Review.

INTRODUCTION: Alzheimer's disease (AD) is the most common form of dementia. There have been various proposed pharmacologic and non-pharmacologic treatments proposed for preventing cognitive decline in AD patients. Transcranial Direct Current Stimulation (tDCS) is a neuromodulation technique used to enhance cognitive functions and motor skills of the brain. Our study aimed to assess the effects of tDCS in AD patients, including effects on general cognitive status, memory, attention, executive functions, language, IQ, and neuropsychological effects, along with the factors influencing the outcomes. METHODS: Systematic searches were conducted for relevant evidence using PubMed, ScienceDirect, and Cochrane Library databases for (Transcranial Direct Current Stimulation) and (Alzheimer's). Duplicates were removed, and the remaining articles were screened for double-blind, placebo-controlled, randomized clinical trials (Phase III), case studies, and case series on patients diagnosed with AD using tDCS. The articles were assessed for full text, and studies were selected and analyzed to include in the review. RESULTS: Overall, 20 studies were reviewed. Cognitive status, executive function and working memory, recognition memory, and language function may improve following AtDCS depending on the stimulation polarity and area stimulated. No significant effects of tDCS were seen on attention, associative memory, recall memory, visuospatial ability, and neuropsychiatric symptoms. DISCUSSION: Therapy outcomes and the factors that could affect them were analyzed, which included the number of sessions taken, current density, stimulation polarity (cathodal/anodal/dual), area stimulated, training(s) given, and study timeline. CONCLUSION: tDCS is a well-tolerated therapy that can be used for improving several cognitive domains in patients having Alzheimer's disease. Its treatment outcomes are affected by polarity (cathodal/ anodal), site of stimulation, number of sessions taken, and any training(s) given during the study.

Degenerative Lumbar Spine Surgeries Under Regional Anesthesia in a Developing Country: An Initial Case Series.

Introduction Current evidence from developed countries on lumbar spine surgeries under regional anesthesia reports it to be superior to general anesthesia (GA) in terms of decreased anesthesia time, operative time, intraoperative complications such as bleeding, postoperative complications, length of hospital stay, and overall cost. We report the first case series from Pakistan on lumbar spine surgeries under regional anesthesia. Methods We utilized spinal anesthesia (SA) for lumbar spine surgeries of 45 patients in a tertiary-care hospital in Karachi, Pakistan. The surgeries were performed as day-care procedures. The preoperative assessments included MRI findings, visual analogue scale (VAS), pre-operative limb powers, and straight leg raise (SLR). Other assessments included total SA time, total surgical time, time of stay in the post-anesthesia care unit (PACU), complications, and total hospital cost. SPSS v26 was used to calculate means and standard deviations. Results We found the total SA time to be about 45 to 60 minutes in most patients (95.6%). The total surgical time was 30 to 45 minutes for most patients. The average time of stay in the PACU was three to four hours. The VAS scores were significantly improved postoperatively with 46.7% (n=21) of patients with a score of 3, 46.7% (n=21) with a score of 2, and 6.7% (n=3) with a score of 1. 71.1% (n=32) patients had day-care surgery, 22.2% (n=10) stayed in the hospital for one day, and 6.7% (n=3) patients stayed for more than one day. Most patients (88.9%, n=40) had no complications, whereas only 11.1% (n=5) complained of PDPH. The total hospital cost was also lesser than procedures under GA. Conclusion We conclude that SA is well tolerated and has favorable outcomes in terms of cost-effectiveness, anesthesia time, surgical time, and hospital stay; therefore, SA should be considered for a greater number of lumbar spine surgeries, especially in low-middle income countries.

Quality of life in survivors of pediatric medulloblastoma: a systematic review and meta-analysis.

INTRODUCTION: Medulloblastoma (MB) is the most common malignant pediatric brain tumor. The mainstay of treatment is maximum surgical resection and craniospinal radiation, which may be followed by chemotherapy. The debilitating effect of the tumor and the intensive treatment approaches in MB lead to long-term neuropsychological, physical, and chronic medical problems. We conducted a systematic review to assess the quality of life (QoL) in the long-term survivors of MB and the factors leading to compromised QoL. METHODS: We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for our review. A comprehensive literature search was performed using PubMed, Cochrane Library, Digital Commons Network, and Wiley Online Library databases to search for articles having quality of life, medulloblastoma, and pediatric survivors in title or abstract. We removed duplicates and screened through titles, and full texts. Twelve articles were included in our study. Articles using and reporting all domains of PaedsQL were included in the meta-analysis. The PaedsQL scores of survivors and their caregivers were compared. Subgroup analysis was conducted for craniospinal and proton radiotherapy groups. RESULTS: As compared to other posterior fossa tumors, MB survivors have the lowest QoL scores. There is a difference in the perception of QoL of survivors between caregivers and survivors themselves with survivors rating themselves higher in several domains. The overall PaedsQL scores were significantly different for both groups (p < 0.001). Subgroup analysis showed that the difference between those who were treated with craniospinal or proton radiation was not significant (p = 0.76). For the subscales, physical (p = 0.005), psychosocial (p = 0.0003), and school (p = 0.03) perceptions were significantly different for the survivors and their caregivers; however, psychosocial (p = 0.80) and emotional (p = 0.93) scales were not different for the survivors or caregivers. Patient characteristics related to a worse QoL included disease severity, metastatic disease, lesser family income, smaller current ventricle size, need for permanent hydrocephalus treatment, and lesser age at diagnosis. CONCLUSION: An analysis of various studies, using different measures of QoL, concludes that QoL is compromised in all pediatric survivors of MB; however, the perception of QoL of the survivors is better than objective or caretaker-rated QoL.

Factors affecting cognitive functions of patients with high-grade gliomas: a systematic review.

BACKGROUND: Gliomas make up approximately 26.5% of all primary CNS tumors and 80.7% of malignant tumors. They are classified according to histology, location, and genetics. Grade III and IV gliomas are considered high-grade gliomas (HGGs). The cognitive signs and symptoms are attributed to mass defects depending on location, growth rapidity, and edema. Our purpose is to review the cognitive status of patients diagnosed with HGGs; the effect of treatments including surgical resection, radiotherapy, and chemotherapy; and the predictors of the cognitive status. METHODS: We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as a template for the methodology. A comprehensive literature search was performed from three databases (PubMed, ScienceDirect, and Cochrane Library) for clinical trials and longitudinal studies on patients diagnosed with HGGs assessing their cognitive status. RESULTS: Thirteen studies were selected among which 9 assessed cognitive function before and after treatment. One assessed the consistency of cognitive complaints and objective cognitive functioning. Three reported factors affecting disease progression and cognitive status. Most HGG patients have impairment in at least one cognitive domain. Treatments including surgical resection or radio-chemotherapy did not impair cognitive status. DISCUSSION: The cognitive status could be used to assess sub-clinical tumor progression. Factors correlated to cognitive status were tumor location, edema, and grade. Patient characteristics correlated were pre-operative epilepsy, corticosteroid use, and age at the time of diagnosis. CONCLUSION: Assessment of the cognitive status of HGG patients indicates sub-clinical tumor progression and may be used to assess treatment outcomes.

Using Psychedelics in Clinical Practice: Comparing Therapeutic Uses and Potential Harms.

Psychedelics might be the oldest psychoactive agents known to be used for inducing religious or mystical experiences. Their strong psychoactive effect was discovered accidentally in 1943 after the synthesis of Lysergic acid diethylamide (LSD) in 1937. These drugs became a mainstream area of research following the synthesis of LSD; however, several political and social factors led to their ban in 1966, after which research on psychedelics remained limited. These drugs became a major topic of scientific and ethical debate in the 1990's and the recent times have seen a 'Psychedelic renaissance' where the therapeutic value of psychedelics is being reconsidered. This article reports the historical perspective of psychedelics, pharmacologic action by 5-HT2A receptor agonism, and psychological effects and compares the proposed therapeutic uses, including uses in depression, PTSD, anxiety- related disorders, drug and alcohol addiction, neurodegenerative diseases, and auto-immune diseases to potential harms including the development of tolerance, hallucinogen persisting perception disorder, and potential psychosis. An analysis of history, pharmacology, and comparison of benefits and harms lead to the conclusion that the potential therapeutic benefits significantly outweigh the potential harms; thus, further research and clinical trials need to be conducted across different countries and cultures for their legal approval in clinical use.

Incidence and comparative prognosis of cancers with metastasis to noncommon sites: A population-based study.

Primary tumors have common sites of metastasis such as lymph nodes, bones, liver, lungs, and brain; however, they can also metastasize to other uncommon sites such as adrenals, bone marrow, and skin among others. Our study aimed to investigate the relationship between uncommon sites of metastasis at the time of diagnosis and median survival in a number of primary tumors using the Surveillance, Epidemiology, and End Results (SEER) database. This retrospective cohort study conducted between September-October 2021 included patient-level SEER data for 2016-2018 using SEER Research Data, 9 Registries, Nov 2020 Sub (1975-2018). Descriptive analysis for complete cohort and median survival for each primary within the cohort was performed using R software. A total of 25,345 patients (females, 51.4%) were diagnosed with primary tumors with metastasis to uncommon sites at the time of diagnosis; the mean age at diagnosis was 68 years. Lung and bronchus primaries constituted the largest proportion of cohort (41.9%) that metastasized to uncommon sites, followed by nonHodgkin lymphoma-nodal (7.4%), pancreas (6.6%), stomach (3.7%), and ovarian (3.4%). The incidence of metastasis to uncommon sites was most common in respiratory cancers in ages 61-80 years (25%) and least in breast primaries in ages 18-40 years (0.1%), and was higher in Whites compared to other races. Regarding median survival, liver cancer with metastasis to uncommon sites had the worst prognosis (1 month), whereas small intestine tumors were associated with a better prognosis, median survival of 13 months. In this cohort study, the lung and bronchus cancers were the most common primaries metastasized to uncommon sites at diagnosis. The liver tumor had the worst survival compared to other tumors. These findings will help redirect the available screening tools to improve survival in patients with primary tumors with metastasis at diagnosis and may also play an essential role in future research and achieve a better prognosis for cancer patients.

Quality of Life in Paediatric Survivors of Medulloblastoma.

Medulloblastoma (MB) is among the most common malignant paediatric brain tumours usually arising in the cerebellum. The treatment is surgical resection followed by craniospinal radiation with or without chemotherapy. We assessed the current literature on survivors of MB and their quality of life (QoL). The QoL of MB survivors is significantly compromised in terms of decreased neurocognitive functions, Intelligence Quotient (IQ), and social functioning. These also lead to a compromised overall performance, school performance, lack of employment, social isolation, and caregiver burden. The survivors often self-reported better performances as compared to objective performance and that rated by the caregivers. The predictors of worse QoL include earlier age at diagnosis, hydrocephalus, shunt placement, altered mental status at diagnosis, incomplete/subtotal resection of the tumour, and metastatic disease.

Lassa fever amidst the COVID-19 pandemic in Africa: A rising concern, efforts, challenges, and future recommendations.

Lassa fever, caused by the Lassa virus of the Arenaviruses family, is a re-emerging public health concern that has led to 300,000 infections and 5000 deaths annually in Africa. Highly prevalent in Sierra Leone, Liberia, Guinea, Nigeria, Côte d'lvoire, Ghana, Togo, and Benin, patients infected with the virus can manifest with cough, sore throat, headache, nausea, and vomiting among other symptoms. Coexisting with the coronavirus disease 2019 (COVID-19) pandemic and its impacts, cases of Lassa fever in the African population have been reported to decrease due to hesitancy in visiting clinics that leads to unreported cases-all contributing to a silent outbreak in West Africa. Thus, to overcome current burdens, gaps, and challenges caused by Lassa fever amidst COVID-19 in Africa, various recommendations for efficient control of transmission, measures for disease containment, and strategies to correct misperceptions were made.

Post-acute sequelae of COVID-19 and the mental health implications.

Post-acute sequelae of COVID-19 (PASC) or more commonly known as Long COVID-19, is the term given to persistent symptoms 12 weeks from the initial presentation of COVID-19 infection. Several multi-organ symptoms have been reported by patients. Some common symptoms include headaches, fatigue, memory impairment and mental health complications such as anxiety and depression. People with previous psychiatric diagnosis are at greater risk of developing longer mental health implications from persistent COVID-19 symptoms. Additionally, healthcare workers are at increased risk of being long haulers leading to burnout and exhaustion. The objective of this review article is to provide comprehensive evidence from existing literature on various symptoms reported by patients experiencing Long COVID-19 and the rate of occurrence of such symptoms in different populations. A long-term disease surveillance is required to further understand the persistent symptoms or the long-term impact of this infection.