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Elsayed S, Cabrera A, Ouellette D, Jones PM, Dhami R, Hanage W. Association of body mass index with COVID-19-related neurologic sequelae: a retrospective cohort study. Clin Exp Med 2023; 23:2239-2251. [PMID: 36525126 PMCID: PMC9755765 DOI: 10.1007/s10238-022-00965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
We sought to explore the relationship between body mass index (BMI) and neurologic outcomes following acute COVID-19 infection. We conducted a retrospective electronic medical record-based cohort study enrolling adults with laboratory-confirmed acute COVID-19 infection who presented to 1 of 12 academic and community hospitals in Southwestern Ontario, Canada between April 1, 2020 and July 31, 2021. Primary subjective (anosmia, dysgeusia, and/or headache) and objective (aseptic meningitis, ataxia, delirium, encephalopathy, encephalitis, intracranial hemorrhage, ischemic stroke, and/or seizure) composite neurologic outcomes were assessed, comparing obese and overweight individuals to those with underweight/normal BMI indices, adjusting for baseline characteristics. Secondary outcomes (severity of illness, length of hospital stay, SARS-CoV-2 viral load, mortality) were similarly analyzed. A total of 1437 enrolled individuals, of whom 307 (21%), 456 (32%), and 674 (47%) were underweight/normal, overweight, and obese, respectively. On multivariable analysis, there was no association between BMI category and the composite outcome for subjective (odds ratio [OR] 1.17, 95% CI 0.84-1.64, Bonferroni p = 1.00 for obese; OR 1.02, 95% CI 0.70-1.48; Bonferroni p = 1.00 for overweight) and objective (OR 0.74, 95% CI 0.42-1.30, p = 0.29 for obese; OR = 0.80, 95% CI 0.45-1.43, p = 0.45 for overweight) neurologic manifestations. There was no association between BMI category and any secondary outcome measure and no evidence of effect modification by age or sex. This study demonstrates the absence of an association between BMI and neurologic manifestations following acute COVID-19 illness. Prospective studies using standardized data collection tools and direct measures of body fat are warranted to obtain more valid effect estimates.
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Affiliation(s)
- Sameer Elsayed
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ana Cabrera
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Danielle Ouellette
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Phil M Jones
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rita Dhami
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - William Hanage
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Taş BM, Alpaydın T, Akçalı S, Kaygusuz S, Özlük Erol Ö, Şencan Z, Cömert E, Bayar Muluk N, Özel G. Evaluation of Clinical Features and Olfactory Functions in COVID-19: A Multicentre Study. Cureus 2023; 15:e40027. [PMID: 37425551 PMCID: PMC10323863 DOI: 10.7759/cureus.40027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Coronavirus Disease-2019 (COVID-19) causes olfactory loss one of the initial diagnostic criteria. The brief smell identification test (BSIT) is an objective test frequently used in olfactory dysfunction. This study aimed to observe the changes in olfactory functions and clinical features in a short time in COVID-19. Methods In this prospective study involving 64 patients, the BSIT was performed at two different times; at the time of first application and on the 14th day. Demographic features, laboratory findings, body mass index (BMI), blood oxygen saturation values (SpO2), complaints at first admission, fever, follow-up place, and treatment schemes were noted. Results There was a significant difference between the BSIT scores at the first admission and when the polymerase chain reaction (PCR) became negative on the 14th day (p<0.001). Low oxygen saturation values at first admission were associated with low BSIT scores. No relationship was found between olfactory functions and complaints at admission, fever, follow-up place, and treatment schemes. Conclusion As a result, negative effects of COVID-19 on olfactory functions have been demonstrated even in the short follow-up period. In addition, low saturation values at first admission were associated with low BSIT scores.
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Affiliation(s)
- Burak Mustafa Taş
- Otolaryngology, Kirikkale University School of Medicine, Kirikkale, TUR
| | - Turgay Alpaydın
- Anesthesiology Clinic, Manisa Merkezefendi State Hospital, Manisa, TUR
| | - Sinem Akçalı
- Medical Microbiology, Celal Bayar University Faculty of Medicine, Manisa, TUR
| | - Sedat Kaygusuz
- Infectious Diseases and Clinical Microbiology, Kırıkkale University School of Medicine, Kırıkkale, TUR
| | - Özlem Özlük Erol
- Infectious Diseases and Clinical Microbiology, Kırıkkale Yüksek Ihtisas Hospital, Kırıkkale, TUR
| | - Ziya Şencan
- Otolaryngology, Kirikkale University School of Medicine, Kirikkale, TUR
| | - Ela Cömert
- Otorhinolaryngology, Head and Neck Surgery, Kırıkkale University School of Medicine, Kırıkkale, TUR
| | - Nuray Bayar Muluk
- Ear Nose Throat, Kirikkale University School of Medicine, Kırıkkale, TUR
| | - Gökçe Özel
- Otorhinolaryngology, Gökçe ÖZEL Clinic, Ankara, TUR
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Rahmani M, Moghadasi AN, Shahi S, Eskandarieh S, Azizi H, Hasanzadeh A, Ahmadzade A, Dehnavi AZ, Farahani RH, Aminianfar M, Naeini AR. COVID-19 and its implications on the clinico-radiological course of multiple sclerosis: A case-control study. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:187-192. [PMID: 36883067 PMCID: PMC9983351 DOI: 10.1016/j.medcle.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/22/2022] [Indexed: 03/06/2023]
Abstract
Background Multiple sclerosis (MS) is an immune-mediated disease that has been related to several risk factors such as various viral infections. We carried out this study in order to establish a relationship between COVID-19 infection and MS severity. Methods In a case-control study, we recruited patients with relapsing-remitting multiple sclerosis (RRMS). Patients were divided into two groups based on positive COVID-19 PCR at the end of the enrollment phase. Each patient was prospectively followed for 12 months. Demographical, clinical, and past medical history were collected during routine clinical practice. Assessments were performed every six months; MRI was performed at enrollment and 12 months later. Results Three hundred and sixty-two patients participated in this study. MS patients with COVID-19 infection had significantly higher increases in the number of MRI lesions (p: 0.019, OR(CI): 6.37(1.54-26.34)) and EDSS scores (p: 0.017), but no difference was found in total annual relapses or relapse rates. COVID-19 infections were positively correlated with EDSS progression (p: 0.02) and the number of new MRI lesions (p: 0.004) and predicted the likelihood of the number of new MRI lesions by an odds of 5.92 (p: 0.018). Conclusion COVID-19 may lead to higher disability scores in the RRMS population and is associated with developing new Gd-enhancing lesions in MRI imaging. However, no difference was observed between the groups regarding the number of relapses during follow-up.
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Affiliation(s)
- Mohammad Rahmani
- Department of Neurology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Shahi
- Tehran Heart Center, Cardiovascular Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Ali Zare Dehnavi
- Department of Neurology, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Hamidi Farahani
- Department of Infectious Diseases, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammad Aminianfar
- Department of Infectious and Tropical Diseases, Be'sat Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Alireza Ranjbar Naeini
- Department of Neurology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
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Oliván-Blázquez B, Bartolomé-Moreno C, Gericó-Aseguinolaza J, Méndez-López F, Lerma-Irureta D, Lamiquiz-Moneo I, Fernández-Martínez S, Magallón-Botaya R. Relationship between initial symptoms and the prognosis, sex, and demographic area of patients with COVID-19. Front Med (Lausanne) 2022; 9:1040062. [PMID: 36590935 PMCID: PMC9795186 DOI: 10.3389/fmed.2022.1040062] [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: 09/08/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background A method of determining the initial symptoms and main prognostic identifiers for COVID-19 can be a key tool for physicians, especially primary care physicians. Therefore, the objective of this study was to examine the prognosis of patients with COVID-19 from two different demographic regions according to baseline and main symptoms, age, and sex. Methods All individuals selected from both urban and rural health centers were over 18 years of age, had COVID-19 before 2 March 2021, and were followed up with a primary care physician. All patients included in this study were recruited in terms of sex, age at the time of infection, type of contact, baseline symptoms, primary and secondary symptomatology, emergency assistance, hospitalization, intensive care unit (ICU) admission, and death. Results A total of 219 and 214 subjects were recruited from rural and urban health centers, respectively. Subjects with COVID-19 from rural areas were significantly older in age, with a higher proportion of men, and had significantly lower baseline and main symptoms than those from urban areas. In addition, the presence of both fever and dyspnea as the initial or main symptom is significantly associated with emergency assistance, hospitalization, and death, regardless of sex, age, and demographic area. This type of illness was reported to be significantly less frequent in the rural population than in the urban population. Conclusion The presence of both fever and dyspnea as both initial and main symptoms is a poor prognostic factor for COVID-19, regardless of age, sex, and demographic areas. In addition, women reported lower levels of fever and dyspnea, requiring minimal emergency assistance and fewer hospitalization, and a lower rate of mortality than men. During a COVID-19 infection follow-up, subjects in rural areas seem to have less access to medical care than those in urban areas.
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Affiliation(s)
- Bárbara Oliván-Blázquez
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain,Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
| | - Cruz Bartolomé-Moreno
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain,Aragonese Healthcare Service, Zaragoza, Spain,Aragonese Healthcare Service, Department of Family and Community Care Teaching- Sector I, Zaragoza, Spain,*Correspondence: Cruz Bartolomé-Moreno
| | | | - Fátima Méndez-López
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain,Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - David Lerma-Irureta
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Itziar Lamiquiz-Moneo
- Miguel Servet University Hospital, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Department of Human Anatomy and Histology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | | | - Rosa Magallón-Botaya
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain,Aragonese Healthcare Service, Zaragoza, Spain,Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
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Goldstein Ferber S, Shoval G, Zalsman G, Weller A. Does COVID-19 related symptomatology indicate a transdiagnostic neuropsychiatric disorder? - Multidisciplinary implications. World J Psychiatry 2022; 12:1004-1015. [PMID: 36158308 PMCID: PMC9476837 DOI: 10.5498/wjp.v12.i8.1004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/28/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
The clinical presentation that emerges from the extensive coronavirus disease 2019 (COVID-19) mental health literature suggests high correlations among many conventional psychiatric diagnoses. Arguments against the use of multiple comorbidities for a single patient have been published long before the pandemic. Concurrently, diagnostic recommendations for use of transdiagnostic considerations for improved treatment have been also published in recent years. In this review, we pose the question of whether a transdiagnostic mental health disease, including psychiatric and neuropsychiatric symptomology, has emerged since the onset of the pandemic. There are many attempts to identify a syndrome related to the pandemic, but none of the validated scales is able to capture the entire psychiatric and neuropsychiatric clinical presentation in infected and non-infected individuals. These scales also only marginally touch the issue of etiology and prevalence. We suggest a working hypothesis termed Complex Stress Reaction Syndrome (CSRS) representing a global psychiatric reaction to the pandemic situation in the general population (Type A) and a neuropsychiatric reaction in infected individuals (Type B) which relates to neurocognitive and psychiatric features which are part (excluding systemic and metabolic dysfunctions) of the syndrome termed in the literature as long COVID. We base our propositions on multidisciplinary scientific data regarding mental health during the global pandemic situation and the effects of viral infection reviewed from Google Scholar and PubMed between February 1, 2022 and March 10, 2022. Search in-clusion criteria were “mental health”, “COVID-19” and “Long COVID”, English language and human studies only. We suggest that this more comprehensive way of understanding COVID-19 complex mental health reactions may promote better prevention and treatment and serve to guide implementation of recommended administrative regulations that were recently published by the World Psychiatric Association. This review may serve as a call for an international investigation of our working hypothesis.
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Affiliation(s)
- Sari Goldstein Ferber
- Department of Psychology and Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5317000, Israel
| | - Gal Shoval
- Department of Psychiatry, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Neuroscience, Princeton University, Princeton, NJ 08544, United States
| | - Gil Zalsman
- Department of Psychiatry, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Psychiatry, Columbia University, New York, NY 10032, United States
| | - Aron Weller
- Department of Psychology and Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5317000, Israel
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6
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Yazdanbakhsh M, Saghaei Dehkordi S. An Overview of Published Articles in Archives of Academic Emergency Medicine in 2021. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e18. [PMID: 35402996 PMCID: PMC8986493 DOI: 10.22037/aaem.v10i1.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mehrnoosh Yazdanbakhsh
- Journal Office, Emergency Ward, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Saghaei Dehkordi
- Journal Office, Emergency Ward, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding author: Somayeh Saghaei Dehkordi; Emergency Ward, Shohadaye Tajrish Hospital, Shahrdari Avenue, Tajrish Square, Tehran, Iran. Tel: 00989388136564
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7
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Zare Dehnavi A, Salehi M, Arab Ahmadi M, Asgardoon MH, Ashrafi F, Ahmadinejad N, Behkar A, Hamidi Farahani R, Hashemi H, Tafakhori A, Shahali H, Rahmani M, Ranjbar Naeini A. Clinical, Laboratory and Imaging Characteristics of Hospitalized COVID-19 Patients with Neurologic Involvement; a Cross-Sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e10. [PMID: 35402993 PMCID: PMC8986495 DOI: 10.22037/aaem.v10i1.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics. Methods This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay. Results Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Conclusion Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.
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Affiliation(s)
- Ali Zare Dehnavi
- Department of Neurology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Infectious Diseases and Tropical Medicines Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Arab Ahmadi
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzad Ashrafi
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Ahmadinejad
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Behkar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hassan Hashemi
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Department of Neurology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamze Shahali
- Department of Aerospace and Sub Aquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammad Rahmani
- Department of Neurology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ranjbar Naeini
- Department of Neurology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.,Corresponding Author: Alireza Ranjbar naeini; AJA University of medical sciences, Etemad zadeh street, Fatemi-Gharbi Street, Tehran, Iran. / Postal Code: 1411718541, E-mail: . Telephone: 021- 86096350,Mobile phone: 0098913 123 0360
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Hannum ME, Koch RJ, Ramirez VA, Marks SS, Toskala AK, Herriman RD, Lin C, Joseph PV, Reed DR. Taste loss as a distinct symptom of COVID-19: A systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.10.09.21264771. [PMID: 34671775 PMCID: PMC8528083 DOI: 10.1101/2021.10.09.21264771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chemosensory scientists have been skeptical that reports of COVID-19 taste loss are genuine, in part because before COVID-19, taste loss was rare and often confused with smell loss. Therefore, to establish the predicted prevalence rate of taste loss in COVID-19 patients, we conducted a systematic review and meta-analysis of 376 papers published in 2020-2021, with 241 meeting all inclusion criteria. Additionally, we explored how methodological differences (direct vs. self-report measures) may affect these estimates. We hypothesized that direct prevalence measures of taste loss would be the most valid because they avoid the taste/smell confusion of self-report. The meta-analysis showed that, among 138,897 COVID-19-positive patients, 39.2% reported taste dysfunction (95% CI: 35.34-43.12%), and the prevalence estimates were slightly but not significantly higher from studies using direct (n = 18) versus self-report (n = 223) methodologies (Q = 0.57, df = 1, p = 0.45). Generally, males reported lower rates of taste loss than did females and taste loss was highest in middle-aged groups. Thus, taste loss is a bona fide symptom COVID-19, meriting further research into the most appropriate direct methods to measure it and its underlying mechanisms.
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Affiliation(s)
| | - Riley J Koch
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Vicente A Ramirez
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
- Department of Public Health, University of California Merced, Merced, CA 95348
| | - Sarah S Marks
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Aurora K Toskala
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Riley D Herriman
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Cailu Lin
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Paule V Joseph
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- Division of Intramural Research, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Danielle R Reed
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
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