Management of cancer patients during the COVID-19 pandemic:A comprehensive review

The novel 2019 corona virus disease also called severe acute respiratory syndrome coronavirus 2 has caused a global pandemic and more than 2.5 million people have been affected globally with over 100000 deaths.The disease has caused an escalation in hospitalization with growing need for hospital beds and intensive care unit for severe cases.Recent evidence has shown that a significant proportion of cancer patients affected by the corona virus present with severe respiratory pneumonia-like illness with need for subsequent intensive care unit ventilation and higher mortality risk.This susceptibility may be due to the immunosuppressive state of patients with malignancy confounded by chemotherapy,immunotherapy and targeted therapy.Many solid tumors(lung cancer,pancreatic cancer)as well as hematological malignancies(leukemias)may require prompt diagnosis and treatment based on the disease aggression and progression.Many centers lack clear guideline on the management of cancer during the pandemic.The objective of this review is to synthesize the available literature and provide recommendations on the management of various soft tissue and hematological malignancies.The review will also assess the management guidelines for hospitalized cancer patients;cancer patients in the outpatient setting as well as available modalities for follow-up.

The Practice of Neurosurgery in Edward Francis Small Teaching Hospital of Banjul, the Gambia

The management of neurosurgical pathologies has become a priority in our regions. Over the years the number of patients consulting in neurosurgical clinics continues to rise. Publications and studies of neurosurgical activities are rare in sub-Saharan Africa and almost inexistent in the Gambia in particular hence the impetus for this study： The Practice of Neurosurgery in EFSTH （Edward Francis Small Teaching Hospital） of Banjul, the Gambia. The objective of this study was to report on all the neurosurgical activities of the Neurosurgery unit of EFSTH of Banjul over an 18-month period. A retrospective study of all the neurosurgical activities of the EFSTH over a period of 18-month was carried out. Data were obtained from the medical records of the hospital categorized according to age groups. Consultation, admission, surgery, morbidity and mortality were evaluated. We included all patients managed in the Neurosurgery unit and excluded patients with insufficient data or missing folders. The Neurosurgery unit had a total of 2,038 patients giving an average of 113 patients seen per month of whom 399 （19.57%） were hospitalized and 127 （6.23%） benefitted from neurosurgical intervention. Morbidities and mortalities of 19 and 47 are respectively. Pediatric population with ages ranging from 0-9 years dominated in our admissions. Male： Female ratio was 2：1. The clinical features in our studies varied according to the diverse pathologies encountered in the study. Imaging was dominated by CT scan 168 cases （61%）, X-Rays 102 cases （37%）. Pathologies seen in the Outpatient consultations were mainly degenerative pathology 938 （46%）, Trauma 391 （21%）, Hydrocephalus and other CNS （Central nervous system） Malformations 325 （16%）. Hospitalizations were mostly dominated by Trauma 300 （75.18%）, Hydrocephalus and other CNS Malformations 41 （9.77%）, degenerative disease 26 （6.52%）. Neurosurgical interventions were mainly trauma 47 （37%）, Hydrocephalus and other CNS Malformations 39 （31%）, Degenerative 15 （12%）. Neurosurgical procedures mainly comprised of Burr hole 18 （14%）, Spina bifida repair 17 （13 %）, Craniotomy 13 （10%）, Ventriculoperitoneal shunt 13 （10%）, Spinal internal fixation 12 （9%） and elevation of depressed skull fracture 11 （8%）. Morbidities encountered included surgical site infection 6 （4.51%）, CSF （cerebrospinal fluid） leak 6 （4.51%） shunt infection 3 （2.26%）. Mortality was mostly from Trauma 33 （8%）, Infection 5 （1.25%） and Hydrocephalus and Other CNS Malformations 4 （1.5%） of the total admissions. Conclusions： Lack of materials （bipolar cautery, operating microscope, （C-arm fluoroscopy in the first 7 months of the study））, consumables （surgical, surgical cotton, gel foam, bone wax etc.） had been an enormous challenge the neurosurgical unit of EFSTH had faced. This study therefore demonstrates the great need of a permanent Neurosurgeon and neurosurgical team in the Gambia.

Current trend in the diagnosis and management of malignant pheochromocytoma:Clinical and prognostic factors

Pheochromocytomas are tumors arising from the chromaffin cell of the adrenal gland and paragangliomas as tumors from extra-adrenal sympathetic chromaffin cells.The combined yearly incidence of pheochromocytoma and paraganglioma(PPGL)is approximately 0.8 per 100000 person/year.Malignant pheochromocytoma is defined only by the presence of metastasis,as there is no confirmatory histology or biomarkers.The most common metastatic sites of these chromaffin tumors are the lymph node,bone,lungs,and liver.This review focuses on relevant clinical and immunohistological factors that are predictive of malignant PPGL or metastasis and determinants of prognosis.Findings showed that the risk of malignant PPGL,along with disease survival,is closely associated with age,primary tumor size,gender,synchronous metastasis,and absence of surgical excision.Other essential biomarkers or immunohistology investigated were galectin-3,COX-2,nm-23,microRNA-210,ERBB-2 overexpression and succinate dehydrogenase subunit mutation,which were predictive of malignancy as well as disease prognosis.Curative resection is possible but most metastatic diseases are amenable to radiopharmaceuticals and chemotherapy due to late presentation.Other therapeutic options,like molecular-targeted therapy,are still undergoing clinical trials.

Expending the Paradigm: Active Surveillance for Intermediate Risk Prostate Cancer

Prostate cancer is the leading male cancer worldwide. There remains a controversy as to which patients have indolent disease and which patients present an aggressive disease needing treatment with intent to cure. Because of quality of life impairment associated with treatment by radiation or surgery, active surveillance (AS) is a valid management option to avoid or differ aggressive treatment. Traditionally, AS was reserved for men with low risk prostate cancer, however intermediate risk patients are more and more found in AS cohorts. The aim of this review is to describe the place of AS in intermediate risk patients and the perspectives offered by such a treatment modality.

The Radial Nerve Entrapment in Pediatric Extension-Type Supracondylar Humeral Fractures. About Two Cases Reports

Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.