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Pulia MS, Herrin R, Robison RD, Gustafson S, Broghammer C, Grant R, Schwei RJ, Rogus-Pulia N. Dysphagia Is an Underrecognized Risk Factor for Viral Pneumonia Severity. Dysphagia 2024:10.1007/s00455-024-10697-z. [PMID: 38676776 DOI: 10.1007/s00455-024-10697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/12/2024] [Indexed: 04/29/2024]
Abstract
The aim of this study was to examine the role of pre-existing dysphagia as a risk factor for COVID-19 severity among adults ≥50 years of age presenting to the emergency department (ED). This was a retrospective cohort study that used electronic health record data from two Midwestern EDs in the same health care system. The sample included patients ≥50 years of age who tested positive for SARS-COV-2 during an ED visit between March 15, 2020 and November 19, 2020. Patients were dichotomized based on documented history of dysphagia. The primary outcome was the highest World Health Organization COVID-19 clinical severity score within 30-days of ED arrival. Patients with a score of <4 were classified as non-severe whereas a score ≥4 was considered severe. Chi-square tests were used to assess differences in clinical severity scores between patients with and without dysphagia. A logistic regression model was created to estimate the odds of a severe COVID-19 clinical score. The sample included 126 patients without dysphagia and 40 patients with dysphagia. Patients with a history of dysphagia were more likely to develop severe COVID-19 disease compared to patients without (65.0% vs. 41.3%, p = 0.015). In multivariable analysis, patients with preexisting dysphagia (OR 2.38, 95% CI: 1.05-5.42; p = 0.038) and diabetes (OR 2.42 95% CI: 1.15-5.30; p = 0.021) had significantly increased odds of developing severe COVID-19. This study showed that a pre-existing diagnosis of dysphagia was independently associated with COVID-19 severity in adults ≥50 years of age.
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Affiliation(s)
- Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, 800 University Bay Drive Suite 310, Madison, WI, 53705, USA.
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin Madison, 1513 University Ave., Madison, WI, USA.
| | - Rachelle Herrin
- University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave., Madison, WI, USA
| | - Raele Donetha Robison
- Department of Medicine, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave.,, Madison, WI, USA
- Center for Health Disparities Research , University of Wisconsin Madison, 600 Highland Ave, MSC 3690, K$, Madison, WI, 53792, USA
| | - Sara Gustafson
- Department of Medicine, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave.,, Madison, WI, USA
| | - Charles Broghammer
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, 800 University Bay Drive Suite 310, Madison, WI, 53705, USA
| | - Rosemary Grant
- University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave., Madison, WI, USA
| | - Rebecca J Schwei
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, 800 University Bay Drive Suite 310, Madison, WI, 53705, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave.,, Madison, WI, USA
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, USA
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Ball L, Meteyard L, Powell RJ. Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists. Eur Arch Otorhinolaryngol 2023; 280:5101-5114. [PMID: 37543958 DOI: 10.1007/s00405-023-08153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The contributing factors of aspiration pneumonia have been well documented. However, there are gaps in the literature regarding identifying the weight associated with each factor and the relationship between factors. METHOD In this study, 20 potential predictors of aspiration pneumonia (with four additional variables) have been applied to historic Speech and Language Therapy records to greater understand the significance of each contributor of aspiration pneumonia. 152 cases with an oropharyngeal dysphagia, and a Speech and Language Therapy recommendation of eating and drinking with known aspiration and the associated potential risk of developing an aspiration pneumonia, were included in the data. These were inpatients and outpatients, and had various diagnoses but all had had a videofluoroscopy. RESULTS Logistic regression analysis found seven factors that were individually significant in predicting the development of aspiration pneumonia with 84.93% sensitivity and 91.03% specificity DISCUSSION: Logistic regression and random forest analyses led to the proposal of a new matrix of predictors of aspiration pneumonia with respective scoring weights for individual and cumulative contributors (a direction for future research).
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Affiliation(s)
- Laura Ball
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
| | - Lotte Meteyard
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Roy J Powell
- NIHR Research Design Service-SW, Exeter, UK
- University of Exeter Medical School, Exeter, UK
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Laryngeal sensory neuropathy caused by COVID-19: findings using laryngeal electromyography. Eur Arch Otorhinolaryngol 2023; 280:3295-3302. [PMID: 36930323 PMCID: PMC10022564 DOI: 10.1007/s00405-023-07895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/18/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Laryngeal sensory neuropathy (LSN) is caused by a disorder of the superior laryngeal nerve or the recurrent laryngeal nerve. A diagnosis of LSN should include laryngeal electromyography (LEMG) and laryngovideostroboscopy (LVS). The aim of this study was to characterize the physical and subjective symptoms of neuropathy in patients diagnosed with LSN following COVID-19. MATERIAL AND METHODS Since the beginning of the COVID-19 pandemic, 6 patients who had recovered from the disease presented to us with LSN symptoms. All patients underwent laryngological and phoniatric examination, objective and subjective voice assessment, and LEMG. RESULTS The most common LSN symptom reported by patients was periodic hoarseness of varying severity. Other common symptoms were the sensation of a foreign body in the throat and voice fatigue. Endoscopy often showed functional abnormalities. The LSN patients could be characterized by LEMG recordings, and all showed abnormal activity of the cricothyroid (CT) muscle. The degree of EMG changes in the CT correlated moderately with the severity of dysphonia. CONCLUSIONS Sensory neuropathy of the larynx may be a long-lasting complication of SARS-COV-2 infection. The severity of EMG neuropathic changes in the CT muscle broadly corresponds to the severity of dysphonia.
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Shu K, Perera S, Mahoney AS, Mao S, Coyle JL, Sejdić E. Temporal Sequence of Laryngeal Vestibule Closure and Reopening is Associated With Airway Protection. Laryngoscope 2023; 133:521-527. [PMID: 35657100 PMCID: PMC9718890 DOI: 10.1002/lary.30222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Upper esophageal sphincter opening (UESO), and laryngeal vestibule closure (LVC) are two essential kinematic events whose timings are crucial for adequate bolus clearance and airway protection during swallowing. Their temporal characteristics can be quantified through time-consuming analysis of videofluoroscopic swallow studies (VFSS). OBJECTIVES We sought to establish a model to predict the odds of penetration or aspiration during swallowing based on 15 temporal factors of UES and laryngeal vestibule kinematics. METHODS Manual temporal measurements and ratings of penetration and aspiration were conducted on a videofluoroscopic dataset of 408 swallows from 99 patients. A generalized estimating equation model was deployed to analyze association between individual factors and the risk of penetration or aspiration. RESULTS The results indicated that the latencies of laryngeal vestibular events and the time lapse between UESO onset and LVC were highly related to penetration or aspiration. The predictive model incorporating patient demographics and bolus presentation showed that delayed LVC by 0.1 s or delayed LVO by 1% of the swallow duration (average 0.018 s) was associated with a 17.19% and 2.68% increase in odds of airway invasion, respectively. CONCLUSION This predictive model provides insight into kinematic factors that underscore the interaction between the intricate timing of laryngeal kinematics and airway protection. Recent investigation in automatic noninvasive or videofluoroscopic detection of laryngeal kinematics would provide clinicians access to objective measurements not commonly quantified in VFSS. Consequently, the temporal and sequential understanding of these kinematics may interpret such measurements to an estimation of the risk of aspiration or penetration which would give rise to rapid computer-assisted dysphagia diagnosis. LEVEL OF EVIDENCE 2 Laryngoscope, 133:521-527, 2023.
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Affiliation(s)
- Kechen Shu
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amanda S. Mahoney
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James L. Coyle
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdić
- Edward S. Rogers Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
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Abstract
Coronavirus (COVID-19) infection usually causes mild symptoms in children. However, serious complications may occur as a result of both acute infection or in association with the multisystem inflammatory syndrome (MIS-C). Dysphagia may develop as a sequela of COVID-19. We review the limited data on dysphagia associated with COVID-19 infection in children. Children can develop acute respiratory distress syndrome (ARDS) due to severe COVID-19 infection leading to endotracheal intubation and mechanical ventilation. These children can possibly develop post-intubation dysphagia. Screening for the presence of dysphagia, in an effort to minimize aspiration, in children with active COVID-19 infection must be done carefully to reduce the risk of transmission of the virus. Those children diagnosed with persistent dysphagia after COVID-19 infection has resolved will need further evaluation and management by pediatric subspecialists experienced in treating children with this condition. We recommend, this evaluation and treatment be done by a pediatric aerodigestive team.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Faculty Office Building, Room 224, 49 North Dunlap Street, Memphis, TN, 38105, USA.
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Zayed AM, Afsah O, Elhadidy T, Abou-Elsaad T. Screening for oropharyngeal dysphagia in hospitalized COVID-19 patients: a prospective study. Eur Arch Otorhinolaryngol 2023; 280:2623-2631. [PMID: 36607433 PMCID: PMC9821362 DOI: 10.1007/s00405-022-07810-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To screen for oropharyngeal dysphagia (OD) in hospitalized COVID-19 patients. METHODS A descriptive longitudinal study was conducted on 500 adult patients with confirmed COVID-19 in the age range of 19-65 years who were admitted to the main university isolation hospital (whether admitted in the ward or the intensive care unit). Screening for OD was done using the Arabic version of the Eating Assessment Tool (EAT-10) and the Yale swallow protocol. RESULTS 45.4% of the admitted and 40.97% of the discharged COVID-19 patients had a positive screen for OD. Several risk factors for OD could be detected. These include older age, longer duration of presenting symptoms of COVID-19, presence of ageusia and anosmia, presence of dysphonia, ICU admission, lower oxygen saturation, higher respiratory rate, presence of OD at admission, longer duration of hospital stay, and use of noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV). CONCLUSIONS Screening for OD in hospitalized COVID-19 patients is a mandatory procedure, whether for admitted or discharged patients.
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Affiliation(s)
- Ahmed Mohamed Zayed
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Omayma Afsah
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Tamer Elhadidy
- Chest Diseases Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Tamer Abou-Elsaad
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
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Martin-Martinez A, Ortega O, Viñas P, Arreola V, Nascimento W, Costa A, Riera SA, Alarcón C, Clavé P. COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic. Clin Nutr 2022; 41:2996-3006. [PMID: 34187698 PMCID: PMC8205257 DOI: 10.1016/j.clnu.2021.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Prevalence and complications of oropharyngeal dysphagia (OD) and malnutrition (MN) in COVID-19 patients is unknown. Our aim was to assess the prevalence, risk factors and clinical outcomes of OD and MN in a general hospital during the first wave of the COVID-19 pandemic. METHODS This was a prospective, observational study involving clinical assessment of OD (Volume-Viscosity Swallowing Test), and nutritional screening (NRS2002) and assessment (GLIM criteria) in COVID-19 patients hospitalized in general wards at the Consorci Sanitari del Maresme, Catalonia, Spain. The clinical characteristics and outcomes of patients were assessed at pre-admission, admission and discharge, and after 3 and 6-months follow-up. RESULTS We included 205 consecutive patients (69.28 ± 17.52 years, Charlson 3.74 ± 2.62, mean hospital stay 16.8 ± 13.0 days). At admission, Barthel Index was 81.3 ± 30.3; BMI 28.5 ± 5.4 kg/m2; OD prevalence 51.7% (44.1% impaired safety of swallow); and 45.5% developed MN with a mean weight loss of 10.1 ± 5.0 kg during hospitalization. OD was an independent risk factor for MN during hospitalization (OR 3.96 [1.45-10.75]), and hospitalization was prolonged in patients with MN compared with those without (21.9 ± 14.8 vs 11.9 ± 8.9 days, respectively; p < 0.0001). OD was independently associated with comorbidities, neurological symptoms, and low functionality. At 6-month follow-up, prevalence of OD was still 23.3% and that of MN only 7.1%. Patients with OD at discharge showed reduced 6-month survival than those without OD at discharge (71.6% vs 92.9%, p < 0.001); in contrast, those with MN at discharge did not show 6-month survival differences compared to those without (85.4% vs 83.8%, p = 0.8). CONCLUSIONS Prevalence and burden of OD and MN in patients hospitalized in COVID-19 wards is very high. Our results suggest that optimizing the management of MN might shorten the hospitalization period but optimizing the management of OD will likely impact the nutritional status of COVID-19 patients and improve their clinical outcomes and survival after hospital discharge. CLINICALTRIALS gov Identifier: NCT04346212.
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Affiliation(s)
- Alberto Martin-Martinez
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Alícia Costa
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Stephanie A Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Claudia Alarcón
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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Muacevic A, Adler JR, AlMaghrabi SJ, Mozahim NF, Mozahim SF, Alsubaie SA, Alsehly AA, Alshuaibi RO, Alotaibi LA, Qashgari FS. Cranial Nerve Impairment Associated With COVID-19 Infections: A Systematic Review. Cureus 2022; 14:e31997. [PMID: 36589199 PMCID: PMC9798034 DOI: 10.7759/cureus.31997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
The COVID-19 pandemic has created huge economic and healthcare burdens. In most cases, the virus affects the lungs and causes respiratory symptoms. Additionally, its impact on the cranial nerves remains unclear. We thus aimed to investigate cranial nerve dysfunction in patients with COVID-19 infection. We conducted a systematic literature search of relevant and eligible literature in five databases: PubMed, Web of Science, Medline, EBSCO, and Google Scholar. Our sample included 21 case reports, one case series with 29 patients, and one analytical study with 135 cases. Participant ages ranged from 23 months to 72 years (mean age of 47.5 ± 19.02). The mean time from respiratory symptoms to the onset of neurological signs was (9.6 ± 7.4) days, and the mean recovery time was (16.3 ± 15.3) days. Cranial nerve impairment associated with COVID-19 infection has affected a large population, from infants to the elderly. Facial and abducent nerves were the most commonly affected cranial nerves with reported good prognosis or complete recovery within a few days to weeks. Olfactory dysfunctions were widely detected among COVID-19 patients.
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Viñas P, Martín-Martínez A, Alarcón C, Riera SA, Miró J, Amadó C, Clavé P, Ortega O. A Comparative Study between the Three Waves of the Pandemic on the Prevalence of Oropharyngeal Dysphagia and Malnutrition among Hospitalized Patients with COVID-19. Nutrients 2022; 14:nu14183826. [PMID: 36145215 PMCID: PMC9502091 DOI: 10.3390/nu14183826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The phenotype of patients affected by COVID-19 disease changed between the waves of the pandemic. We assessed the prevalence of oropharyngeal dysphagia (OD), malnutrition (MN), and mortality between the first three waves of COVID-19 patients in a general hospital. Methods: a prospective observational study between April 2020–May 2021. Clinical assessment for OD was made with the volume-viscosity swallowing test; nutritional assessment was performed consistent with GLIM criteria. A multimodal intervention was implemented in the second and third wave, including (a) texturized diets—fork mashable (1900 kcal + 90 g protein) or pureed (1700 kcal + 75 g protein), (b) oral nutritional supplements (500–600 kcal + 25–30 g protein), and (c) fluid thickening (250 mPa·s or 800 mPa·s). Results: We included 205 patients (69.3 ± 17.6 years) in the 1st, 200 (66.4 ± 17.5 years) in the 2nd, and 200 (72.0 ± 16.3 years;) in the 3rd wave (p = 0.004). On admission, prevalence of OD was 51.7%, 31.3% and 35.1%, and MN, 45.9%, 36.8% and 34.7%, respectively; mortality was 10.7%, 13.6% and 19.1%. OD was independently associated with age, delirium, and MN; MN, with age, OD, diarrhea and ICU admission; mortality, with age, OD and MN. (4) Conclusions: Prevalence of OD, MN and mortality was very high among COVID-19 patients. OD was independently associated with MN and mortality. An early and proactive multimodal nutritional intervention improved patients’ nutritional status.
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Affiliation(s)
- Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Claudia Alarcón
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Stephanie A. Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Jaume Miró
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Cristina Amadó
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-741-77-00 (ext. 1046)
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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Aoyagi Y, Mori E, Ishii H, Kono Y, Sato A, Okochi Y, Funahashi R, Kagaya H. Poor walking ability outcome and activities of daily living improvement in patients undergoing cardiac rehabilitation during COVID-19 pandemic. Eur J Phys Rehabil Med 2022; 58:606-611. [PMID: 34870386 PMCID: PMC9980481 DOI: 10.23736/s1973-9087.21.07054-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had wide-ranging impacts across international healthcare systems and direct impacts on rehabilitation professionals. Few outcome data for cardiac patients undergoing rehabilitation programs during the COVID-19 pandemic are available. AIM We conducted a study to compare the effect of modified rehabilitation therapies mainly performed in wards versus conventional therapies mainly performed in rehabilitation units in which exercise on a treadmill and cardiopulmonary exercise testing were available. DESIGN Observational study. SETTING University hospital. POPULATION Fifty-five consecutive inpatients admitted to a university hospital and underwent a cardiac rehabilitation program from August 2019 to June 2020. METHODS The patients were divided into two groups: those admitted during the COVID-19 outbreak (Group A, N.=28) and those admitted before the COVID-19 outbreak (Group B, N.=27). The evaluation included age, sex, duration of the rehabilitation intervention program, days before initiation of the rehabilitation program, functional status, and Functional Independence Measure (FIM) Score. RESULTS A higher proportion of patients in Group A than B underwent a cardiac rehabilitation program provided in wards (88.5% vs. 48.8%, respectively). Group A showed a significantly lower 6-minute walking distance and walking speed than Group B at discharge (P=0.031 and 0.014, respectively). Group A showed a significantly shorter exercise time using an ergometer than Group B (P=0.028). CONCLUSIONS The difference in the cardiac rehabilitation location during the COVID-19 pandemic may affect the rehabilitation contents and lead to less improvement in physical function. CLINICAL REHABILITATION IMPACT A cardiac rehabilitation program was performed mainly in wards instead of in rehabilitation units during the COVID-19 pandemic. Walking abilities were adversely affected by the modified cardiac rehabilitation program.
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Affiliation(s)
- Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan - .,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan -
| | - Etsuko Mori
- Faculty of Rehabilitation, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Yuji Kono
- Faculty of Rehabilitation, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Ayako Sato
- Faculty of Rehabilitation, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Yuki Okochi
- Faculty of Rehabilitation, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Reisuke Funahashi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Helding L, Carroll TL, Nix J, Johns MM, LeBorgne WD, Meyer D. COVID-19 After Effects: Concerns for Singers. J Voice 2022; 36:586.e7-586.e14. [PMID: 32839055 PMCID: PMC7409791 DOI: 10.1016/j.jvoice.2020.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Lynn Helding
- Vocology and Voice Pedagogy University of Southern California, Thornton School of Music, Los Angeles, CA, USA
| | - Thomas L Carroll
- Department of Otolaryngology, Head and Neck Surgery Harvard Medical School, Boston, MA, USA
| | - John Nix
- Voice and Voice Pedagogy University of Texas at San Antonio, San Antonio, TX, USA
| | - Michael M Johns
- USC Voice Center Division Director, Laryngology Professor USC Caruso, Department of Otolaryngology Head and Neck Surgery, Los Angeles, CA, USA
| | - Wendy D LeBorgne
- The Blaine Block Institute for Voice Analysis and Rehabilitation, The Professional Voice Center of Greater Cincinnati University of Cincinnati, CIncinnati, OH, USA
| | - David Meyer
- Janette Ogg Voice Research Center, Shenandoah Conservatory, Winchester, VA, USA.
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12
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Screening Tools Designed to Assess and Evaluate Oropharyngeal Dysphagia in Adult Patients: A Scoping Review. NURSING REPORTS 2022; 12:245-258. [PMID: 35466245 PMCID: PMC9036293 DOI: 10.3390/nursrep12020025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Oropharyngeal Dysphagia (OD) significantly decreases a patient’s quality of life and poses a high economic burden to institutions. In this sense, evaluation and assessment are important interventions for health professionals, although current tools and instruments are multiple and are dispersed in the literature. The aim of this review was to map existing screening tools to assess and evaluate OD in adult patients, identify their relevant clinical parameters and respective contexts of use and provide a systematic approach and summary to better inform practice. A scoping review was developed guided by the JBI methodology and using PRISMA-ScR to report results published between 2014 and 2021, in English, Spanish and Portuguese. Databases included Medline, Academic Search Complete, CINAHL Complete, Scielo, Google Scholar, ScienceDirect, OpenGrey and B-On. Mendeley was used to store and screen data. A total of 33 studies were included in the study, of which 19 tools were identified, some being intervention-based tools and others an algorithm for decision. The most common context used was in the general population and older adults. Regarding clinical parameters, the most common were food consistency, presence of the cough reflex, swallowing effort, voice changes and weight. As oropharyngeal dysphagia concerns important risks for the patient, a rigorous assessment must be performed. In this sense, the review identified specific disease-related tools and more general instruments, and it is an important contribution to more efficient dysphagia screening and prevention.
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Allisan‐Arrighi AE, Rapoport SK, Laitman BM, Bahethi R, Mori M, Woo P, Genden E, Courey M, Kirke DN. Long‐term upper aerodigestive sequelae as a result of infection with
COVID
‐19. Laryngoscope Investig Otolaryngol 2022; 7:476-485. [PMID: 35434347 PMCID: PMC9008172 DOI: 10.1002/lio2.763] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/06/2021] [Accepted: 01/31/2022] [Indexed: 01/14/2023] Open
Abstract
Objectives Respiratory, voice, and swallowing difficulties after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may result secondary to upper airway disease from prolonged intubation or mechanisms related to the virus itself. We examined a cohort who presented with new laryngeal complaints following documented SARS‐CoV‐2 infection. We characterized their voice, airway, and/or swallowing symptoms and reviewed the clinical course of their complaints to understand how the natural history of these symptoms relates to COVID‐19 infections. Methods Retrospective review of patients who presented to our department with upper aerodigestive complaints as sequelae of prior infection with, and management of, SARS‐CoV‐2. Results Eighty‐one patients met the inclusion criteria. Median age was 54.23 years (±17.36). Most common presenting symptoms were dysphonia (n = 58, 71.6%), dysphagia/odynophagia (n = 16, 19.75%), and sore throat (n = 9, 11.11%). Thirty‐one patients (38.27%) presented after intubation. Mean length of intubation was 16.85 days (range 1–35). Eighteen patients underwent tracheostomy and were decannulated after an average of 70.69 days (range 23–160). Patients with history of intubation were significantly more likely than nonintubated patients to be diagnosed with a granuloma (8 vs. 0, respectively, p < .01). Fifty patients (61.73%) were treated for SARS‐CoV‐2 without requiring intubation and were significantly more likely to be diagnosed with muscle tension dysphonia (19 vs. 1, p < .01) and laryngopharyngeal reflux (18 vs. 1, p < .01). Conclusion In patients with persistent dyspnea, dysphonia, or dysphagia after recovering from SARS‐CoV‐2, early otolaryngology consultation should be considered. Accurate diagnosis and prompt management of these common underlying etiologies may improve long‐term patient outcomes. Level of evidence 4
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Affiliation(s)
- Annie E. Allisan‐Arrighi
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Sarah K. Rapoport
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Benjamin M. Laitman
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Rohini Bahethi
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Matthew Mori
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Peak Woo
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Eric Genden
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Mark Courey
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Diana N. Kirke
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
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Vengalil S, Mahale R, Chakradhar N, Alluri S, Sagar Navanith PR, Ganaraja VH, Haripriya KR, Vikram HV, Asranna A, Mailankody P, Seshagiri DV, Cheerla HM, Maturu VN, Vaddepally CR, Kenchaiah R, Srijithesh PR, Chaudhuri JR, Netravathi M, Alladi S. The Spectrum of Neuro-COVID: A Study of a Comprehensively Investigated Large Cohort from India. Ann Indian Acad Neurol 2022; 25:194-202. [PMID: 35693675 PMCID: PMC9175391 DOI: 10.4103/aian.aian_310_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Though reports of neurological manifestations of COVID-19 have emerged from various parts of the world, the cohorts reported are from the West and mostly derived from electronic databases. Much remains unknown regarding neuro-COVID in developing countries. India is the second-worst affected country, and this study reports the neurological manifestations of COVID-19 in a comprehensively evaluated cohort. Objective: The aim of this study was to describe the range of neurological manifestations of COVID-19 in India with an emphasis on the risk factors, laboratory and imaging findings and short-term outcome. Methods: Retrospective review of hospital records of all confirmed COVID-19 patients with neurological manifestations, receiving inpatient care in two neurology referral hospitals were done. All demographic, clinical details, investigations, and treatment were analysed. Results: A total of 120 confirmed COVID-19 cases presenting with neurological symptoms were included. The mean age of illness and duration of illness was 48.03 ± 17.3 years and 10.9 ± 17.3 days respectively. New onset of neurological symptoms occurred in 100 cases while 20 patients had worsening of pre-existing neurological illness. Stroke was the commonest neurological disorder (43%), followed by encephalopathy (23%) and Guillain-Barre syndrome (10%). Other unusual neurological manifestations included new-onset headache (7%), seizures including denovo status epilepticus (5%) and meningo-encephalitis (5%). Nearly half of the patients had preceding COVID-19 symptoms. Poor outcome at discharge was seen in 40% and mortality occurred in 15%. Conclusion: Stroke and encephalopathy constitute the most common neurological manifestations. The absence of preceding COVID-19 symptoms in nearly half the cases is striking. Poor outcome was seen in nearly 50% despite early recognition and management.
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Affiliation(s)
- Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - N Chakradhar
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - Swathi Alluri
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - P R Sagar Navanith
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - V H Ganaraja
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - K R Haripriya
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Holla Venkappayya Vikram
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ajay Asranna
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Doniparthi V Seshagiri
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - H Manoj Cheerla
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - V N Maturu
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - C R Vaddepally
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - Raghavendra Kenchaiah
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - P R Srijithesh
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jaydip Ray Chaudhuri
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Clunie GM, Bolton L, Lovell L, Bradley E, Bond C, Bennington S, Roe J. Considerations for speech and language therapy management of dysphagia in patients who are critically ill with COVID-19: a single centre case series. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patients treated with intubation and tracheostomy for COVID-19 infection are at risk of increased incidence of laryngeal injury, dysphagia and dysphonia. Because of the novelty of the SARS-CoV-2 virus, little is known about the type of dysphagia patients experience as a result of infection and critical illness. The aim of this case series report was to progress understanding of COVID-19 and dysphagia following admission to an intensive care unit and to guide speech and language therapy clinical practice in the ongoing pandemic. Methods A retrospective case review was conducted of all patients at Imperial College Healthcare NHS Trust, London who underwent a tracheostomy because of COVID-19 and received an instrumental assessment of swallowing in the early stages of the pandemic. Results A total of 11 patients were identified, and descriptive statistics were used to present demographic data, with a narrative account of their dysphagia profile used to describe presentation. Causes and presentation of dysphagia were heterogenous, with each patient requiring individualised clinical management to maximise outcome. A positive trend was seen in terms of recovery trajectory and progressing to oral intake. Conclusions This study reports on early experience of the presentation of dysphagia in patients with COVID-19 and demonstrates the value of instrumental assessment. It indicates the need for further research to consolidate knowledge and guide clinical practice.
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Affiliation(s)
- Gemma M Clunie
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lee Bolton
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Lindsay Lovell
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Bradley
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Cara Bond
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Bennington
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Roe
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Stefanou MI, Palaiodimou L, Bakola E, Smyrnis N, Papadopoulou M, Paraskevas GP, Rizos E, Boutati E, Grigoriadis N, Krogias C, Giannopoulos S, Tsiodras S, Gaga M, Tsivgoulis G. Neurological manifestations of long-COVID syndrome: a narrative review. Ther Adv Chronic Dis 2022; 13:20406223221076890. [PMID: 35198136 PMCID: PMC8859684 DOI: 10.1177/20406223221076890] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Abstract
Accumulating evidence points toward a very high prevalence of prolonged neurological symptoms among coronavirus disease 2019 (COVID-19) survivors. To date, there are no solidified criteria for 'long-COVID' diagnosis. Nevertheless, 'long-COVID' is conceptualized as a multi-organ disorder with a wide spectrum of clinical manifestations that may be indicative of underlying pulmonary, cardiovascular, endocrine, hematologic, renal, gastrointestinal, dermatologic, immunological, psychiatric, or neurological disease. Involvement of the central or peripheral nervous system is noted in more than one-third of patients with antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while an approximately threefold higher incidence of neurological symptoms is recorded in observational studies including patient-reported data. The most frequent neurological manifestations of 'long-COVID' encompass fatigue; 'brain fog'; headache; cognitive impairment; sleep, mood, smell, or taste disorders; myalgias; sensorimotor deficits; and dysautonomia. Although very limited evidence exists to date on the pathophysiological mechanisms implicated in the manifestation of 'long-COVID', neuroinflammatory and oxidative stress processes are thought to prevail in propagating neurological 'long-COVID' sequelae. In this narrative review, we sought to present a comprehensive overview of our current understanding of clinical features, risk factors, and pathophysiological processes of neurological 'long-COVID' sequelae. Moreover, we propose diagnostic and therapeutic algorithms that may aid in the prompt recognition and management of underlying causes of neurological symptoms that persist beyond the resolution of acute COVID-19. Furthermore, as causal treatments for 'long-COVID' are currently unavailable, we propose therapeutic approaches for symptom-oriented management of neurological 'long-COVID' symptoms. In addition, we emphasize that collaborative research initiatives are urgently needed to expedite the development of preventive and therapeutic strategies for neurological 'long-COVID' sequelae.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Smyrnis
- Second Department of Psychiatry, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Physiotherapy, University of West Attica, Athens, Greece
| | - George P. Paraskevas
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Boutati
- Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Grigoriadis
- Second Department of Neurology, ‘AHEPA’ University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sotirios Giannopoulos
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Gaga
- 7th Respiratory Medicine Department and Asthma Center, Athens Chest Hospital ‘Sotiria’, Athens, Greece
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[Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic]. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2022; 87:63-79. [PMID: 34728891 PMCID: PMC8554136 DOI: 10.1016/j.rgmx.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/05/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The SARS-CoV-2 virus that causes the COVID-19 disease is transmitted through the inhalation of droplets or aerosols and inoculation via the oronasal or ocular routes, transforming the management of swallowing disorders into a challenge for healthcare teams, given their proximity to the aerodigestive tract and the high probability of aerosol generation during patient evaluation and treatment. AIM To provide essential guidance for Latin American multidisciplinary teams, regarding the evaluation and treatment of oropharyngeal and esophageal dysphagia, at the different levels of healthcare. The position statement was formulated for the purpose of maintaining medical service continuity, in the context of a pandemic, and minimizing the propagation and infection risks of the virus. METHODS Thirteen experts in swallowing disorders were summoned by the Latin American Dysphagia Society to formulate a series of clinical suggestions, based on available evidence and clinical experience, for the management of dysphagia, taking the characteristics of Latin American healthcare systems into account. RESULTS The position statement of the Latin American Dysphagia Society provides a series of clinical suggestions directed at the multidisciplinary teams that manage patients with oropharyngeal and esophageal dysphagia. It presents guidelines for evaluation and treatment in different contexts, from hospitalization to home care. CONCLUSIONS The present statement should be analyzed by each team or healthcare professional, to reduce the risk for COVID-19 infection and achieve the best therapeutic results, while at the same time, being mindful of the reality of each Latin American country.
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Manzano-Aquiahuatl C, Tobar-Fredes R, Zavala-Solares MR, Salle-Levy D, Imamura R, Morales-Fernández R, Ojeda-Peña L, Parra-Reyes D, Santoro P, Ton V, Trujillo-Benavides OE, Vargas-García MA, Furkim AM. Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021; 87:63-79. [PMID: 34973937 PMCID: PMC8716087 DOI: 10.1016/j.rgmxen.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The SARS-CoV-2 virus that causes the COVID-19 disease is transmitted through the inhalation of droplets or aerosols and inoculation via the oronasal or ocular routes, transforming the management of swallowing disorders into a challenge for healthcare teams, given their proximity to the aerodigestive tract and the high probability of aerosol generation during patient evaluation and treatment. Aim To provide essential guidance for Latin American multidisciplinary teams, regarding the evaluation and treatment of oropharyngeal and esophageal dysphagia, at the different levels of healthcare. The position statement was formulated for the purpose of maintaining medical service continuity, in the context of a pandemic, and minimizing the propagation and infection risks of the virus. Methods Thirteen experts in swallowing disorders were summoned by the Latin American Dysphagia Society to formulate a series of clinical suggestions, based on available evidence and clinical experience, for the management of dysphagia, taking the characteristics of Latin American healthcare systems into account. Results The position statement of the Latin American Dysphagia Society provides a series of clinical suggestions directed at the multidisciplinary teams that manage patients with oropharyngeal and esophageal dysphagia. It presents guidelines for evaluation and treatment in different contexts, from hospitalization to home care. Conclusions The present statement should be analyzed by each team or healthcare professional, to reduce the risk for COVID-19 infection and achieve the best therapeutic results, while at the same time, being mindful of the reality of each Latin American country.
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Affiliation(s)
- C Manzano-Aquiahuatl
- Sociedad Latinoamericana de Disfagia (The Latin American Dysphagia Society); Sociedad Mexicana de Disfagia, Mexico City, Mexico
| | - R Tobar-Fredes
- Sociedad Chilena de Deglución y Alimentación, Santiago, Chile; Departamento de Fonoaudiología, Universidad de Chile, Santiago, Chile//Unidad de Fonoaudiología, Hospital del Trabajador, Santiago, Chile
| | - M R Zavala-Solares
- Sociedad Mexicana de Disfagia, Mexico City, Mexico; Escuela de Altos Estudios en Salud, Universidad La Salle México, Mexico City, Mexico
| | - D Salle-Levy
- Academia Brasileira de Disfagia, Sao Paulo, Brazil; Departamento de Disfagia de la Sociedad Brasileira de Fonoaudiología, Brazil
| | - R Imamura
- Academia Brasileira de Laringología y Voz, Brazil; Hospital de las Clínicas de la Facultad de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brazil
| | - R Morales-Fernández
- Sociedad Latinoamericana de Disfagia (The Latin American Dysphagia Society); Instituto Nacional de Rehabilitación Pedro Aguirre Cerda, Santiago, Chile
| | - L Ojeda-Peña
- Sociedad Latinoamericana de Disfagia (The Latin American Dysphagia Society); Asociación Paraguaya de Disfagia, Asunción, Paraguay
| | - D Parra-Reyes
- Sociedad Latinoamericana de Disfagia (The Latin American Dysphagia Society); Sociedad Peruana de Disfagia, Lima, Peru
| | - P Santoro
- Academia Brasileira de Laringología y Voz, Brazil; Hospital de las Clínicas de la Facultad de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brazil
| | - V Ton
- Asociación Argentina de Disfagia, Buenos Aires, Argentina; Departamento de Endoscopia Hospital General de Zona No. 42. Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - O E Trujillo-Benavides
- Departamento de Endoscopia Hospital General de Zona No. 42. Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - M A Vargas-García
- Sociedad Latinoamericana de Disfagia (The Latin American Dysphagia Society); Departamento de Fonoaudiología, Universidad Metropolitana, Barranquilla, Colombia
| | - A M Furkim
- Sociedad Latinoamericana de Disfagia (The Latin American Dysphagia Society); Universidad Federal de Santa Catarina, Curso de Fonoaudiología, Florianópolis, Brazil.
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Yamada Y, Kawakami M, Tashiro S, Omori M, Matsuura D, Abe R, Osada M, Tashima H, Shimomura T, Mori N, Wada A, Ishikawa A, Tsuji T. Rehabilitation in acute COVID-19 patients: A Japanese retrospective, observational, multi-institutional survey. Arch Phys Med Rehabil 2021; 103:929-936. [PMID: 34896082 PMCID: PMC8651527 DOI: 10.1016/j.apmr.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/14/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate the changes in activities of daily living (ADLs) and the conditions of rehabilitation for acute COVID-19 patients in Japan. DESIGN Retrospective, observational survey. SETTING Four tertiary hospitals with intensive care units and one secondary hospital in Japan. PATIENTS COVID-19 patients (N=478) admitted to five hospitals INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES Walking ability and swallowing status were assessed using the Functional Independence Measure (FIM) locomotion item and Food Intake Scale (FILS) at admission and discharge. The physiatrists of each hospital were also surveyed regarding the factors that influenced decisions to provide rehabilitation. RESULTS Excluding patients who died, the proportion of critical patients who could walk independently at discharge was 63%, and the proportion of those who were able to take three meals orally at discharge was 90%. Rehabilitation was provided to 13.4% of all patients, in particular to 58.3% of patients with critical symptoms. CONCLUSIONS After COVID-19 treatment, patients, especially those with critical symptoms, still have functional disabilities related to walking and swallowing. During the period studied, it is possible that sufficient rehabilitation could not be provided.
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Affiliation(s)
- Yuka Yamada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Syoichi Tashiro
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Maiko Omori
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Daisuke Matsuura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Reon Abe
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Maiko Osada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan
| | - Hiroyuki Tashima
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tadasuke Shimomura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ayako Wada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Wan D, Du T, Hong W, Chen L, Que H, Lu S, Peng X. Neurological complications and infection mechanism of SARS-COV-2. Signal Transduct Target Ther 2021; 6:406. [PMID: 34815399 PMCID: PMC8609271 DOI: 10.1038/s41392-021-00818-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/27/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Currently, SARS-CoV-2 has caused a global pandemic and threatened many lives. Although SARS-CoV-2 mainly causes respiratory diseases, growing data indicate that SARS-CoV-2 can also invade the central nervous system (CNS) and peripheral nervous system (PNS) causing multiple neurological diseases, such as encephalitis, encephalopathy, Guillain-Barré syndrome, meningitis, and skeletal muscular symptoms. Despite the increasing incidences of clinical neurological complications of SARS-CoV-2, the precise neuroinvasion mechanisms of SARS-CoV-2 have not been fully established. In this review, we primarily describe the clinical neurological complications associated with SARS-CoV-2 and discuss the potential mechanisms through which SARS-CoV-2 invades the brain based on the current evidence. Finally, we summarize the experimental models were used to study SARS-CoV-2 neuroinvasion. These data form the basis for studies on the significance of SARS-CoV-2 infection in the brain.
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Affiliation(s)
- Dandan Wan
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Tingfu Du
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China
| | - Weiqi Hong
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Li Chen
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Haiying Que
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Shuaiyao Lu
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China.
| | - Xiaozhong Peng
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China.
- State Key Laboratory of Medical Molecular Biology, Department of Molecular, Biology and Biochemistry, Institute of Basic Medical Sciences, Medical Primate Research Center, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
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21
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Touihmi S, El Hassouni A, Rkain I. Sars-Cov-19 associated with aspiration pneumonia in a patient with Parkinson disease: A case report. Eur J Radiol Open 2021; 8:100379. [PMID: 34632001 PMCID: PMC8486677 DOI: 10.1016/j.ejro.2021.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 11/23/2022] Open
Abstract
Coronaviruses can cause multiple systemic infections respiratory complications are the most recognizable symptoms similar to severe acute respiratory syndrome coronavirus (SARS-CoV). Aspiration pneumonia was the most common reason for the Emergency admission of patients with PD.Here we report the case a patient with Parkinson’s disease admitted for respiratory insufficiency secondary to Covid-19 and aspiration pneumonia. A 78-years- old male patient, treated for Parkinson’s disease, was admitted to the emergency department with symptoms of acute respiratory insufficiency. Four days before his admission, the patient suffered from solid dysphagia. On physical examination, the patient was obnibulated, febrile at 39 °, with clinical signs of respiratory insuffisiency. Computed tomography of the neck and Chest showed patchy areas of subpleural ground glass opacities with vascular dilatation associated with bilateral posterobasal and anterior consolidations with air overlapping imaging characteristics of aspiration and covid 19 pneumonia. The CT scan also showed an oesophageal hypodensity consistant with endoluminal foreign body. Reverse transcription-polymerase chain reaction (RT-PCR) for COVID-19 was positive.The diagnosis of Sars-cov 19 associated with aspiration pneumonia were retained. An esophagoscopy was realized, a foreign body visualized in the upper sphincter of the esophagus and an impacted food bolus was retracted. We would like to emphasize the challenging differential diagnosis of pneumonia caused by aspiration of different materials and Sars-cov 19. Definite discrimination of the two diagnoses might be impossible. Some radiologic features may suggest one diagnos over the other. While lobar or segmental pneumonia, lung abscess, and empyema have been reported as Complications of aspirations pneumonia these outcomes are rarely Considered Complications of COVID-19 pneumonia. Centrilobular nodules and tree-in-bud sign are commonly seen in cases with aspiration. Interestingly, these CT findings are not frequent in COVID-19 pneumonia and have been categorized as “Atypical” by the Radiological Society of North America (RSNA), and therefore could be of some Value in proposing a differential diagnosis. Bilateral subpleural patches of ground-glass opacity (GGO), especially in basal distribution, have been described as typical for the diagnosis of COVID-19 pneumonia in suspected Cases. Such a presentation is also fairly common in aspiration Pneumonia.
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Affiliation(s)
- Safaa Touihmi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Tangier-Morocco, University of Abdelmalek Essaadi, Tangier, Morocco
| | - Adam El Hassouni
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Tangier-Morocco, University of Abdelmalek Essaadi, Tangier, Morocco
| | - Ilham Rkain
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Tangier-Morocco, University of Abdelmalek Essaadi, Tangier, Morocco
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22
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Abstract
ABSTRACT Coronavirus disease 2019 might have an impact on patients with Parkinson disease because of the neuroinvasive potential. Herein, we report the case of a patient with Parkinson disease who developed severe and prolonged oropharyngeal dysphagia after a coronavirus disease 2019 infection. A 73-yr-old male patient with Parkinson disease was diagnosed with coronavirus disease 2019 and admitted to a tertiary care hospital. Before hospitalization, he was assessed at Hoehn and Yahr stage 4 and showed no symptoms of dysphagia. After admission, the patient gradually recovered; however, he was fed through a nasogastric tube. A videofluoroscopic swallowing study revealed a severe oropharyngeal dysphagia with a severely delayed oral phase. Therefore, he underwent percutaneous gastrostomy tube insertion. After discharge, although he received swallowing therapy for 4 mos, he still had severe dysphagia, which made him dependent on enteral feeding. We speculate that the impact of coronavirus disease 2019 on dopaminergic and nondopaminergic mechanisms could lead to the development of dysphagia in this patient. The present case suggests that clinicians must have a high index of suspicion without dismissing the possibility of dysphagia and subsequent aspiration pneumonia in coronavirus disease 2019 patients with Parkinson disease.
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23
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Vagus nerve neuropathy related to SARS COV-2 infection. IDCases 2021; 26:e01242. [PMID: 34401328 PMCID: PMC8357529 DOI: 10.1016/j.idcr.2021.e01242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 01/07/2023] Open
Abstract
A 38-year-old woman with confirmed SARS-CoV-2 infection developed dysphagia to both solids and liquids. A fiberoptic nasolaryngoscopy and a videofluoroscopy swallowing study showed right vocal cord paresis, tenth cranial nerve neuropathy, as well as oral, hypopharynx, and supraglottic hypoesthesia. Orotracheal intubation was not required. The patient was fully recovered after undergoing a multidisciplinary rehabilitation program that included speech and deglutition therapy.
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24
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Can SARS-CoV-2 infect the central nervous system via the olfactory bulb or the blood-brain barrier? Brain Behav Immun 2021; 95:7-14. [PMID: 33412255 PMCID: PMC7836942 DOI: 10.1016/j.bbi.2020.12.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/17/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China in December 2019. On February 11, the World Health Organization (WHO) announced the name for the new illness caused by SARS-CoV-2: COVID-19. By March 11, the outbreak of COVID-19 was declared a pandemic by the WHO. This virus has extensively altered daily life for many across the globe, while claiming hundreds of thousands of lives. While fundamentally a respiratory illness, many infected individuals experience symptoms that involve the central nervous system (CNS). It is likely that many of these symptoms are the result of the virus residing outside of the CNS. However, the current evidence does indicate that the SARS-CoV-2 virus can use olfactory neurons (or other nerve tracts) to travel from the periphery into the CNS, and that the virus may also enter the brain through the blood-brain barrier (BBB). We discuss how the virus may use established infection mechanisms (ACE2, NRP1, TMPRSS2, furin and Cathepsin L), as well mechanisms still under consideration (BASIGIN) to infect and spread throughout the CNS. Confirming the impact of the virus on the CNS will be crucial in dealing with the long-term consequences of the epidemic.
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25
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Oropharyngeal Dysphagia After Hospitalization for COVID-19 Disease: Our Screening Results. Dysphagia 2021; 37:447-453. [PMID: 34165644 PMCID: PMC8222948 DOI: 10.1007/s00455-021-10325-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/08/2021] [Indexed: 01/28/2023]
Abstract
A high percentage of patients suffered symptoms also after recovery from the Coronavirus Disease—2019 (COVID-19) infection. It is not well clear what are the specific long-term sequelae (complications and symptoms). During the acute phase the patients may develop a multi-organ system pathology including aerodigestive tract. As the pathophysiology of COVID-19 emerges, the aim of our study was to describe the prevalence of oropharyngeal dysphagia after COVID-19 disease. From March to July 2020 we enrolled patients recovered from SARS-CoV-2 infection who had been previously hospitalized for the disease. They were screened for dysphagia by mean of the Eating Assessment Tool-10 (EAT-10). The cases with EAT-10 score > 3 were graded for the aspiration risk by applying the Gugging Swallowing Screen (GUSS) and were submitted to the Swal-QoL questionnaire. The cases with a GUSS score > 19 were subjected to FEES. 8/117 (7%) patients had positive screening result. 4/8 (50%) revealed an abnormal health related quality of life in oropharyngeal dysphagia with a mean Swal-QoL score of 69.73. The most affected domain was the “time of meals” (mean score 65) following by the “sleep” (mean score 66) and “eating desire” (mean score 72). 1/8 cases showed increased risk for aspiration and did not showed endoscopic signs of oropharyngeal dysphagia. Our results showed that the prevalence of upper dysphagia after hospitalization for SARS-CoV-2 is not anecdotal and that probably this long-lasting sequela has a psychogenic etiology.
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26
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Can B, İsmagulova N, Enver N, Tufan A, Cinel İ. Sarcopenic dysphagia following COVID-19 infection: A new danger. Nutr Clin Pract 2021; 36:828-832. [PMID: 34161626 PMCID: PMC8441725 DOI: 10.1002/ncp.10731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Oropharyngeal dysphagia is one of the complications of endotracheal intubation. As expected, cases of dysphagia following coronavirus disease 2019 (COVID‐19) reported to date have all been intubated. We here report a case of sarcopenic dysphagia following severe COVID‐19 pneumonia in a nonintubated older adult. The patient was an 85‐year‐old male who was readmitted to the hospital with dysphagia and subsequent aspiration pneumonia in the first week after his discharge from the COVID‐19 unit. On physical examination, the patient was sarcopenic and malnourished. Flexible endoscopic evaluation of swallowing (FEES) revealed aspiration into the airway. Enteral feeding was initiated and the infusion rate gradually increased to achieve the desired protein‐energy targets. Control FEES 2 months after discharge showed recovery of swallowing function, with no apparent penetration or aspiration. Clinicians caring for patients with COVID‐19 should be aware that dysphagia, which is associated with increased mortality in older adults, may occur even in the absence of intubation. We recommend that the evaluation of dysphagia be part of the clinical assessment in older COVID‐19 patients with malnutrition or sarcopenia.
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Affiliation(s)
- Büşra Can
- Division of Geriatrics, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Narkiza İsmagulova
- Department of Infectious Diseases, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Necati Enver
- Department of Otorhinolaryngology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Aslı Tufan
- Division of Geriatrics, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - İsmail Cinel
- Department of Anesthesiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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27
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Jungbauer F, Hülse R, Lu F, Ludwig S, Held V, Rotter N, Schell A. Case Report: Bilateral Palsy of the Vocal Cords After COVID-19 Infection. Front Neurol 2021; 12:619545. [PMID: 34093389 PMCID: PMC8172591 DOI: 10.3389/fneur.2021.619545] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/20/2021] [Indexed: 01/08/2023] Open
Abstract
During the COVID-19 pandemic, adverse neurological effects have been described. In addition to unspecific neurological symptoms, cranial nerve deficits have appeared as part of SARS-CoV-2 infection. In this case report, we describe a 74-year-old patient who developed bilateral paralysis of the vocal cords some weeks following his dismissal in stable condition after COVID-19 pneumonia. After ruling out central lesions, peripheral tumors, and other possible causes, therapy was initiated with methylprednisolone, inhalations, and oxygen. The patient showed no improvement, so laterofixation after Lichtenberger was performed. The dyspnea worsened after several weeks, so a laser posterior cordectomy was performed with satisfactory outcome.
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Affiliation(s)
- Frederic Jungbauer
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Roland Hülse
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Fei Lu
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Sonja Ludwig
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Valentin Held
- Department for Neurology, University Medical Centre Mannheim, Mannheim, Germany
| | - Nicole Rotter
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Angela Schell
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
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28
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Aoyagi Y, Inamoto Y, Shibata S, Kagaya H, Otaka Y, Saitoh E. Clinical Manifestation, Evaluation, and Rehabilitative Strategy of Dysphagia Associated With COVID-19. Am J Phys Med Rehabil 2021; 100:424-431. [PMID: 33657028 PMCID: PMC8032217 DOI: 10.1097/phm.0000000000001735] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
ABSTRACT Dysphagia is the difficulty in swallowing because of the presence of certain diseases; it particularly compromises the oral and/or pharyngeal stages. In severe acute respiratory syndrome coronavirus 2 infection, neuromuscular complications, prolonged bed rest, and endotracheal intubation target different levels of the swallowing network. Thus, critically ill patients are prone to dysphagia and aspiration pneumonia. In this review, we first discuss the possible cause and pathophysiology underlying dysphagia associated with coronavirus disease 2019, including cerebrovascular events, such as stroke, encephalomyelitis, encephalopathy, peripheral neuropathy, and myositis, that may lead to the dysphagia reported as a complication associated with the coronavirus disease 2019. Next, we present some recommendations for dysphagia evaluation with modifications that would allow a safe and comprehensive assessment based on available evidence to date, including critical considerations of the appropriate use of personal protective equipment and optimization individual's noninstrumental swallowing tasks evaluation, while preserving instrumental assessments for urgent cases only. Finally, we discuss a practical managing strategy for dysphagia rehabilitation to ensure safe and efficient practice in the risks of severe acute respiratory syndrome coronavirus 2 exposure, in which swallowing therapy using newer technology, such as telerehabilitation system or wearable device, would be considered as a useful option.
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29
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COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients. Nutrients 2021; 13:nu13041113. [PMID: 33805263 PMCID: PMC8065805 DOI: 10.3390/nu13041113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/05/2021] [Accepted: 03/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background: In older people with psychoneurological diseases, COVID-19 infection may be associated with a risk of developing or exacerbating dysphagia. The aim of the present study was to examine the relationship between eating/swallowing function and COVID-19 infection. Methods: Subjects were 44 inpatients with confirmed COVID-19 infection being treated for schizophrenia in a psychiatric ward. Eating function was assessed using the Food Intake Level Scale (FILS) before and after infection. We also evaluated age, comorbidities, COVID-19 hospital stay, obesity index, weight loss rate, and chlorpromazine equivalent. Results: Subjects had a mean age of 68.86 years. Pre-infection, 20 subjects had a FILS score of 7–9 (presence of eating/swallowing disorder) and 24 subjects had a score of 10 (normal). Eating function after infection resolution showed decreasing FILS score compared to that before infection in 14 subjects (74.14 years). Six subjects (79.3 years) transitioned from oral feeding to parenteral feeding. A ≥ 10% weight loss during infection treatment was significantly associated with decreased eating function and a transition to parenteral feeding. Chlorpromazine equivalents, comorbidities, and number of days of hospitalization showed no associations with decreased eating function. Conclusions: Preventing malnutrition during treatment for COVID-19 infection is important for improving post-infection life prognosis and maintaining quality of life (QOL).
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30
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Lehmann HC, Schoser B, Wunderlich G, Berlit P, Fink GR. [Neuromuscular complications of SARS-CoV-2 infections-Part 1: peripheral nerves]. DER NERVENARZT 2021; 92:540-547. [PMID: 33770191 PMCID: PMC7994351 DOI: 10.1007/s00115-021-01094-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 01/05/2023]
Abstract
In recent months various disorders and diseases of the peripheral nerves (including cranial nerves) and the musculature have been described in association with the pulmonary disease coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the first part of our review the current knowledge about a potential association of a SARS-CoV‑2 infection with dysfunction and diseases of cranial and peripheral nerves is discussed. Anosmia, ageusia, motor cranial nerve involvement and Guillain-Barré syndrome (GBS) were described in a temporal association with a SARS-CoV‑2 infection. Several studies could show that anosmia and ageusia were frequent symptoms of a SARS-CoV‑2 infection. In contrast the failure of other cranial nerves has so far only been sporadically described. A number of case reports and case series indicate a causal association between a SARS-CoV‑2 infection and GBS but epidemiological evidence is still lacking.
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Affiliation(s)
- Helmar C Lehmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Benedikt Schoser
- LMU Klinikum, Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Gilbert Wunderlich
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Zentrum für Seltene Erkrankungen, Universitätsklinikum Köln, Köln, Deutschland
| | - Peter Berlit
- Deutsche Gesellschaft für Neurologie (DGN), Reinhardtstr. 27C, 10117, Berlin, Deutschland
| | - Gereon R Fink
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Institut für Neurowissenschaften (INM-3), Forschungszentrum Jülich, Jülich, Deutschland
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31
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De Vincentis G, Ferrari C, Guerini Rocco D. Severe oropharyngeal dysphagia following COVID-19: a case report. Clin Case Rep 2021; 9:1539-1543. [PMID: 33768884 PMCID: PMC7981729 DOI: 10.1002/ccr3.3819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
Dysphagia may occur after a prolonged intubation due to COVID-19 but it is usually mild. Case reports on severe dysphagia following COVID-19 are infrequent. Diagnosis can be difficult because international indications recommend avoiding instrumental assessments as far as possible because of the infection risk. An early rehabilitation treatment is recommended.
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Affiliation(s)
| | - Chiara Ferrari
- Rehabilitation UnitASST Bergamo EstBriolini HospitalBergamoItaly
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32
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Chadd K, Moyse K, Enderby P. Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients. Front Neurol 2021; 12:629190. [PMID: 33679590 PMCID: PMC7930219 DOI: 10.3389/fneur.2021.629190] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction: The UK's response to the COVID-19 pandemic presented multiple challenges to healthcare services including the suspension of non-urgent care. The impact on neurorehabilitation professions, including speech and language therapy (SLT), has been substantial. Objectives: To review the changes to SLT services triggered by the COVID-19 pandemic with respect to referral rates, service delivery and outcomes, as well as examining the contribution of SLTs to the neurorehabilitation of COVID-19 patients. Methods: Two surveys were distributed to Royal College of Speech and Language Therapists (RCSLT) members exploring experiences of service provision at 6 weeks and 22 weeks after the pandemic was declared in the UK. Responses to closed-ended questions, including questions regarding referral numbers were analyzed descriptively and compared at the two time-points. A database comprising routine clinical data from SLT services across the UK was used to compare information on patients receiving services prior to and during the pandemic. Data on COVID-19 patients was extracted, and findings are provided descriptively. Results: Referrals to SLT services during the acute COVID-19 period in the UK were substantially less than in the same period in 2019. A number of service changes were common including adopting more flexible approaches to provision (such as tele-therapy) and being unable to provide services to some patients. Database analysis suggests fewer patients have accessed SLT since the pandemic began, including a reduction in neurorehabilitation patients. For those who received SLT, the outcomes did not change. SLTs supported a range of needs of COVID-19 patients. Treatment outcomes for COVID-19 patients with dysphagia were positive. Discussion: The pandemic has affected neurorehabilitation and SLT services broadly: referral patterns are different, usual care has been disrupted and interventions have been modified affecting the impact on patient outcomes both positively and negatively. Some patients with COVID-19 require and benefit from SLT intervention.
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Affiliation(s)
- Katie Chadd
- Research and Outcomes, Royal College of Speech and Language Therapists, London, United Kingdom
| | - Kathryn Moyse
- Research and Outcomes, Royal College of Speech and Language Therapists, London, United Kingdom
| | - Pam Enderby
- Health Services Research, The University of Sheffield, Sheffield, United Kingdom
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33
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Odriozola A, Ortega L, Martinez L, Odriozola S, Torrens A, Corroleu D, Martínez S, Ponce M, Meije Y, Presas M, Duarte A, Belén Odriozola M, Malik RA. Widespread sensory neuropathy in diabetic patients hospitalized with severe COVID-19 infection. Diabetes Res Clin Pract 2021; 172:108631. [PMID: 33346072 PMCID: PMC7746125 DOI: 10.1016/j.diabres.2020.108631] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 12/12/2020] [Indexed: 12/11/2022]
Abstract
AIMS To characterize the distribution and severity of sensory neuropathy using a portable quantitative sensory testing (QST) device in diabetic patients (DM) hospitalized with severe COVID-19 infection. METHODS Four patients with diabetes and severe SARS-CoV-2 requiring non-invasive ventilation for a protracted duration underwent clinical, laboratory and radiologic assessment and detailed evaluation of neuropathic symptoms, neurological assessment, QST on the dorsum of the foot and face using NerveCheck Master with assessment of taste and smell. RESULTS All four subjects developed neuropathic symptoms characterized by numbness in the feet with preserved reflexes. QST confirmed symmetrical abnormality of vibration and thermal thresholds in both lower limbs in all patients and an abnormal heat pain threshold on the face of two patients and altered taste and smell. CONCLUSIONS Severe COVID-19 infection with hypoxemia is associated with neuropathic symptoms and widespread sensory dysfunction in patients with DM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
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34
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Vergara J, Lirani-Silva C, Brodsky MB, Miles A, Clavé P, Nascimento W, Mourão LF. Potential Influence of Olfactory, Gustatory, and Pharyngolaryngeal Sensory Dysfunctions on Swallowing Physiology in COVID-19. Otolaryngol Head Neck Surg 2020; 164:1134-1135. [PMID: 33167752 DOI: 10.1177/0194599820972680] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Persistent smell and taste disorders have been reported as some of the most common symptoms after COVID-19 (coronavirus disease 2019). Sensory, olfactory, and gustatory functions perform an important role in the initiation and modulation of oropharyngeal swallow biomechanics and salivation as well as in mealtime enjoyment and appetite. Yet, the details of this interaction remain relatively unknown in patients who are infected with and recovering from COVID-19. In this commentary, we discuss the possible impacts of SARS-CoV-2 on the central and peripheral nervous system and consider the pathophysiology of olfactory, gustatory, and pharyngolaryngeal sensory deficits and its influence on deglutition, describing hypotheses and offering guidance for future research.
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Affiliation(s)
- José Vergara
- Department of Surgery, University of Campinas, Campinas, Brazil
| | - Camila Lirani-Silva
- Gerontology Postgraduate Program, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University, Baltimore Maryland, USA
| | - Anna Miles
- Speech Science, University of Auckland, Auckland, New Zealand
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (Ciberehd), Hospital de Mataró, Autonomous University of Barcelona, Barcelona, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (Ciberehd), Hospital de Mataró, Autonomous University of Barcelona, Barcelona, Spain
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35
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Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci 2020; 41:3437-3470. [PMID: 33089477 PMCID: PMC7577367 DOI: 10.1007/s10072-020-04801-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronaviruses mainly affect the respiratory system; however, there are reports of SARS-CoV and MERS-CoV causing neurological manifestations. We aimed at discussing the various neurological manifestations of SARS-CoV-2 infection and to estimate the prevalence of each of them. METHODS We searched the following electronic databases; PubMed, MEDLINE, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, Cochrane Library, WHO database, and ClinicalTrials.gov . Relevant MeSH terms for COVID-19 and neurological manifestations were used. Randomized controlled trials, non-randomized controlled trials, case-control studies, cohort studies, cross-sectional studies, case series, and case reports were included in the study. To estimate the overall proportion of each neurological manifestations, the study employed meta-analysis of proportions using a random-effects model. RESULTS Pooled prevalence of each neurological manifestations are, smell disturbances (35.8%; 95% CI 21.4-50.2), taste disturbances (38.5%; 95%CI 24.0-53.0), myalgia (19.3%; 95% CI 15.1-23.6), headache (14.7%; 95% CI 10.4-18.9), dizziness (6.1%; 95% CI 3.1-9.2), and syncope (1.8%; 95% CI 0.9-4.6). Pooled prevalence of acute cerebrovascular disease was (2.3%; 95%CI 1.0-3.6), of which majority were ischaemic stroke (2.1%; 95% CI 0.9-3.3), followed by haemorrhagic stroke (0.4%; 95% CI 0.2-0.6), and cerebral venous thrombosis (0.3%; 95% CI 0.1-0.6). CONCLUSIONS Neurological symptoms are common in SARS-CoV-2 infection, and from the large number of cases reported from all over the world daily, the prevalence of neurological features might increase again. Identifying some neurological manifestations like smell and taste disturbances can be used to screen patients with COVID-19 so that early identification and isolation is possible.
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Cavalagli A, Peiti G, Conti C, Penati R, Vavassori F, Taveggia G. Cranial nerves impairment in post-acute oropharyngeal dysphagia after COVID-19. Eur J Phys Rehabil Med 2020; 56:853-857. [PMID: 32940446 DOI: 10.23736/s1973-9087.20.06452-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND According to literature, after COVID-19, patients may require rehabilitation care because of different degrees of physical impairments. Neurologic disorders are often described but no specific data about postacute cranial nerves involvement and possible correlation with dysphagia development are yet available. CASE REPORT The patient is a 69-year-old man who presented acquired weakness and dysphagia with clinical cranial nerves impairment of lingual, IX, X and XII after SARS-CoV-2 infection, without electrophysiological alterations. He underwent rehabilitation program for two months, with slow recovery. However, at discharge residual hypoglossal nerve deficit sign was present. CLINICAL REHABILITATION IMPACT This single case expands knowledge about clinical picture after SARS-CoV-2 disease. Is important to notice that cranial, particularly bulbar nerves could be involved as late complications. Thus, we discuss about risk factors, the nature of the damage and the impact in dysphagia pathophysiology and recovery. If supported by further studies, this case may help to understand dysphagia features in these patients.
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Affiliation(s)
- Angela Cavalagli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy -
| | - Greta Peiti
- Department of Rehabilitation, Habilita Care and Research Hospitals, Clinical Institute of Sarnico, Sarnico, Bergamo, Italy
| | - Corrado Conti
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rachele Penati
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Vavassori
- Department of Rehabilitation, Habilita Care and Research Hospitals, Clinical Institute of Sarnico, Sarnico, Bergamo, Italy
| | - Giovanni Taveggia
- Department of Rehabilitation, Habilita Care and Research Hospitals, Clinical Institute of Sarnico, Sarnico, Bergamo, Italy
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Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci 2020; 41:3039-3056. [PMID: 32935156 PMCID: PMC7491599 DOI: 10.1007/s10072-020-04708-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids.
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Affiliation(s)
- Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | | | - Ankit Gupta
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | - Nidhi Tejan
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
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Ceravolo MG, Arienti C, de Sire A, Andrenelli E, Negrini F, Lazzarini SG, Patrini M, Negrini S. Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Eur J Phys Rehabil Med 2020; 56:642-651. [PMID: 32705860 DOI: 10.23736/s1973-9087.20.06501-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This paper improves the methodology of the first edition of the rapid living systematic review started in April 2020, with the aim to gather and present the current evidence informing rehabilitation of patients with COVID-19 and/or describing the consequences due to the disease and its treatment. EVIDENCE ACQUISITION The Cochrane methodology for a rapid living systematic review was applied. Primary research papers, published from 1 January to 30 June 2020, reporting patients' data, with no limits of study design were included. Studies were categorized for study design, research question, COVID-19 phase, limitations of functioning (disability) of rehabilitation interest and type of rehabilitation service involved. Methodological quality assessment was based on the Cochrane Risk of Bias tools, and the level of evidence table (OCEBM 2011) for all the other studies. EVIDENCE SYNTHESIS Thirty-six, out of 3703 papers, were included. One paper was of level 2 (RCT), 7 were of level 3 (2 cohort studies, 2 cross-sectional studies and 3 case-control studies), and 28 papers of level 4 (descriptive studies); 61% of papers reported epidemiological data on clinical presentations, 5 investigated natural history/determining factors, 1 searched prevalence, 2 studies reported on intervention efficacy (though not on harms), and 5 studies looked at health service organization. CONCLUSIONS Main issues emerging from the review: it is advised to test for COVID-19 people with neurological disorders presenting with symptom changes; dysphagia is a frequent complication after oro-tracheal intubation in COVID-19 patients admitted to the ICU; after discharge, COVID-19 survivors may report persistent restrictive ventilatory deficits regardless of disease severity; there is only sparse and low quality evidence concerning the efficacy of any rehabilitation intervention to promote functional recovery; a substantial increase in resource (staff and equipment) is needed for rehabilitation.
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Affiliation(s)
- Maria G Ceravolo
- Department of Experimental and Clinical Medicine, "Politecnica delle Marche" University, Ancona, Italy
| | | | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Unit of Rehabilitation, Mons. L. Novarese Hospital, Moncrivello, Vercelli, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, "Politecnica delle Marche" University, Ancona, Italy -
| | | | | | | | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, La Statale University, Milan, Italy
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