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.

[Infectious pleurisy as first sign of multiple myeloma in a young 28 years old]

Multiple myeloma is a malignant proliferation of plasma cells, mainly affecting the bone marrow. It rarely occurs in young patients. The medical observation study reveals multiple myeloma discovered through a purulent pleurisy in a 28-year-old subject. This patient was admitted to the pneumology service of the Mohamed V military hospital in Rabat for a fever and dyspnea evolving into a context of poor general condition. Clinical examination found a right pleural fluid effusion syndrome. The pleural puncture reveals a germ-free exudative purulent fluid without plasma cells. The myeloma diagnosis was suspected due to the combination of an aplastic normochromic normocytic anemia at 4.5g/dL of hemoglobin, an accelerated erythrocyte sedimentation rate, hypercalcemia, renal failure and osteolytic lesions located mainly in the skull and pelvis area, oriented by electrophoresis and serum protein immunosubstraction revealing a narrow peak in monoclonal beta-2 globulin at 70.56g/L with a lambda monoclonal gammopathy with immunoglobulin G, and confirmed by the myelogram showing a 74% rate of bone marrow plasma cells. The occurrence of myeloma at a young age is rare and the purulent pleurisy without plasma cells is a rare form of presentation and represents a poor prognosis.

[Delay in the diagnosis of primary bronchial cancer. Study carried out in the pneumology unit of Ibn Sina university hospital, Rabat (Morocco)]

INTRODUCTION

Primary bronchial cancer (PBC) is a major public health problem. The diagnosis is often late resulting in a poor prognosis.

PURPOSE

To determine the factors leading to a late diagnosis.

PATIENTS AND METHODS

All PBCs diagnosed between 01 January and 31 December were included. The factors studied were: "age, sex, smoking, place of residence, socioeconomic level, clinical signs, diagnostic means, histological types, the stages and date of treatment". The date of the first symptom (D1s), the date of care (Dpch), the date of the diagnosis (Ddg) and the date of the beginning of treatment (Dttt) were used to determine the delay before care.

RESULTS

One hundred and three cases of PBC were included. The medium delay before hospitalisation (D1s to Dpch) was 76 days, the delay before the diagnosis (Dpch to Ddg) was 25 days, the time before treatment (Ddg to Dttt) was 27 days, the time between hospitalisation and treatment (Dpch to Dttt) was 69 days, the overall delay (D1s to Dttt) was 160 days. The time before the diagnosis was longer in cases with a low socioeconomic level (30 days vs. 21 days, p: 0.06). The time before treatment was shorter for small cell carcinomas (SCC) (23 days vs. 31 days: p: 0.06). The time between hospitalisation and treatment was shorter for stages IIIB and IV of NSCBC (60 days vs. 67 days, p: 0.03). The overall delay was shorter for SCC (152 days vs. 168 days, p: 0.001).

CONCLUSION

The study confirms the problem of a delay in diagnosis. The effect of these delays on the prognosis has not been demonstrated and requires further study.

Complications de la revaccination par le BCG : 12 observations

INTRODUCTION

Calmette-Guérin bacillus (BCG) is a live attenuated strain used in tuberculosis vaccination. Local and systemic side-effects, although rare, are associated with BCG vaccine. They are common in cases of overdose and with poor vaccination techniques. These complications also occur in some cases of revaccination.

PATIENTS AND METHODS

This was a retrospective study over a period of 5 years between January 2000 and March 2005. 12 patients presenting complications following revaccination with BCG were observed. Patients were revaccinated with BCG following a negative intradermal reaction test. The following parameters were recorded: age, gender, history, vaccination method, type of complication, treatment and outcome.

RESULTS

There were 10 men and 2 and women of mean age 21 years (19 to 23 years). Mean time to consultation was 4 weeks. Complications comprised subcutaneous abscess in 8 cases, deep chronic ulcers in 4 cases complicated by humeral osteitis in one case. The dose administered was 0.1 ml in 9 patients and 1 ml in 3 others (i.e. 10 times the recommended dose). Six patients had extensive and progressive ulceration, with one positive culture, the presence of a granuloma with caseum necrosis and one case of humeral osteitis, and specific treatment was given.

DISCUSSION

Revaccination is no longer recommended by the WHO since efficacy is considered to be low or even nil. Intradermal injection is the reference method for BCG vaccination. Technical errors such as injection of an excessively high dose of the vaccine or subcutaneous administration of the vaccine solution increase the incidence of adverse effects. In our study, three patients erroneously received 1 ml of vaccine and the injection was too deep in 9 cases. There are few reports in the literature concerning the underlying mechanisms of these post-revaccination accidents; two major physiopathological mechanisms, infectious and immunological, are discussed. There is no consensus regarding treatment of these complications. Six of the 12 patients received specific therapy for 6 months.

[Pulmonary artery aneurysms in Behcet syndrome]

Behcet syndrome is a systemic disease with venous tropism, generally expressed by thrombosis and phlebitis. Arterial involvement is more exceptional but can lead to aneurysm of the pulmonary artery, generally not more than three. We report a patient with Behcet syndrome who developed multiple aneurysms of the pulmonary artery and discuss the clinical, radiological aspects as well as the disease course and therapeutic management.

[A rare cause of posterior mediastinal tumors: extramedullary hematopoiesis]

We report a case of a patient with intrathoracic extramedullary hematopoiesis presenting as a posterior mediastinal tumor, without associated myelofibrosis. Pathophysiology and the options for diagnosis and treatment in this condition are discussed.

[Chronic alveolar syndrome]

We report a case of primary pulmonary Hodgkin's disease in a 20 year-old woman. The chest x-ray showed a chronic alveolar syndrome. The diagnosis was established from a pulmonary biopsy. The radiological features and the options for diagnosis of primary pulmonary Hodgkin's disease are discussed.

[Pulmonary leptospirosis. Two cases]

Leptospirosis is a systemic infection transmitted to man by a variety of animals. Classical manifestations include fever, liver and renal involvement, meningoencephalitis and hemorrhage. Pulmonary involvement is less common, generally expressed by hemoptysis and bilateral reticulonodular infiltration on the chest x-ray. Pulmonary disease is one of the principal causes of mortality. We report the cases of two patients aged 22 and 32 years who were hospitalized for moderately abundant hemopysis and fever. The diagnosis of leptospirosis with pulmonary involvement, strongly suggested by the classical extrapulmonary signs and was confirmed later. The patients were given antibiotics (amoxicillin, cycline). Clinical, biological and radiological outcome was favorable.

General Method for Asymmetric Synthesis of alpha-Methylsulfinyl Ketones: Application to the Synthesis of Optically Pure Oxisuran and Bioisosteres

The first asymmetric synthesis of oxisuran [1, (methylsulfinyl)methyl 2-pyridyl ketone], a synthetic immunosuppressive drug, is described. Both enantiomers were efficiently synthesized, in optically pure form, using DAG methodology for the key condensation step. Attempts to couple metal enolates of aryl methyl ketones with chiral sulfinyl compounds led to some epimerization at sulfur. This loss of chirality was circumvented by reacting the alpha-lithio derivatives of the N,N-dimethylhydrazones derived from these ketones with either the (R)- or the (S)-methanesulfinate of diacetone D-glucose, to yield the corresponding alpha-(methylsulfinyl)methylhydrazones, with complete inversion of chirality at sulfur. Hydrolysis of the resulting hydrazones with copper(II) chloride gave 1 in optically pure form. The generality of the method was demonstrated by the preparation of the optically active oxisuran analogs, 2-4, in which the pyridyl moiety was replaced by phenyl, furyl, and thienyl moieties, respectively. The optical purities of these products were determined by proton NMR spectroscopy, using chiral shift reagents, following conditions established by the study of racemic mixtures of the beta-keto sulfoxides.