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Background The COVID-19 pandemic has profoundly affected cancer services. Our objective was to determine the effect of the COVID-19 pandemic on decision making and the resulting outcomes for patients with newly diagnosed or recurrent intracranial tumours. Methods We performed a multi-centre prospective study of all adult patients discussed in weekly neuro-oncology and skull base multidisciplinary team meetings who had a newly diagnosed or recurrent intracranial (excluding pituitary) tumour between 01 April and 31 May 2020. All patients had at least 30-day follow-up data. Descriptive statistical reporting was used. Results There were 1357 referrals for newly diagnosed or recurrent intracranial tumours across fifteen neuro-oncology centres. Of centres with all intracranial tumours, a change in initial management was reported in 8.6% of cases (n=104/1210). Decisions to change the management plan reduced over time from a peak of 19% referrals at the start of the study to 0% by the end of the study period. Changes in management were reported in 16% (n=75/466) of cases previously recommended for surgery and 28% of cases previously recommended for chemotherapy (n=20/72). The reported SARS-CoV-2 infection rate was similar in surgical and non-surgical patients (2.6% vs. 2.4%, p>0.9). Conclusions Disruption to neuro-oncology services in the UK caused by the COVID-19 pandemic was most marked in the first month, affecting all diagnoses. Patients considered for chemotherapy were most affected. In those recommended surgical treatment this was successfully completed. Longer-term outcome data will evaluate oncological treatments received by these patients and overall survival.

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Distinct changes can be observed in the odor of human excretions during health and disease. Identifying underlying volatile metabolites responsible for these odorous changes can be correlated with the pathological process within the body. Advances in the technology have enabled us to interpret the volatile signature of these changes in the odor. This has opened a promising area to lay the foundations of a rapid, noninvasive and point of care diagnostic tool. This review explores the diagnostic potential of volatile organic metabolites as novel biomarkers and extends the discussion on the clinical applications of these biomarkers in gastrointestinal disorders.

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Background Some studies have shown a protective association between aspirin use and subarachnoid haemorrhage (SAH). Other studies have found no relationship or the reverse. These studies differ in their study populations and definitions of SAH. Aims Our aim was to establish 1) if there is an association between aspirin and SAH, 2) how this differs between the general population and those with intracranial aneurysms. Summary of review Studies reporting aspirin use and the occurrence of SAH were included and grouped based on population (general population vs aneurysm population). Odds ratios, hazard ratios and confidence intervals were combined in random-effects models. 11 studies were included. Overall, there was an association between aspirin and SAH (OR 0.68 [0.48, 0.96]). However, populations were diverse and heterogeneity between studies high (p<0.00001), questioning the validity of combining these studies and justifying analysis by population. In the general population there was no difference in aspirin use between individuals with and without SAH (OR 1.15 [0.96, 1.38]). In patients with intracranial aneurysms, aspirin use was greater in patients without SAH (OR 0.37 [0.24, 0.58]), although these studies were at higher risk of bias. Conclusions There is an association between aspirin use and SAH in patients with intracranial aneurysms. This apparent protective relationship is not seen in the general population. Prospective randomised studies are required to further investigate the effect of aspirin on unruptured intracranial aneurysms.

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