Anosmia and ageusia are emerging as symptoms in patients with COVID-19: What does the current evidence say?

The impact of long COVID on health-related quality of life in patients 6 months after discharge with severe COVID-19

This study investigates the relationship between long COVID and health-related quality of life (HRQOL) in patients discharged for 6 months. It included 192 patients with a history of severe COVID-19 and 192 patients with a history of non-severe COVID-19 patients that were selected through quota sampling methods from the Medical Care Monitoring Center (MCMC) of hospitals in Shiraz, Iran, in 2020. Phone-based interviews were conducted to collect data using the short form of the 12-item health-related quality of life (SF-12) questionnaire. Descriptive statistics, including mean (standard deviation) and frequency (percentage), were utilized. Statistical tests, such as the chi-squared test, independent samples t-test, Fisher's exact test, and multiple linear regression models were performed. Statistical analysis was performed using SPSS software version 24, with a significance level of 0.05. Among 384 patients, 79.95% were married, with a mean age of 53.95 years. The majority of patients in both groups were male (57.81% in the severe group and 51.04% in the non-severe group). Patients with severe COVID-19 had significantly lower quality of life scores compared to those with non-severe COVID-19 (p < 0.001, 34.45 [SD = 6.59] versus 39.64 [SD = 5.07]). Furthermore, multiple linear regression analysis indicated that severe COVID-19 inducts a significant negative effect on HRQOL in patients after adjustment of confounders (p < 0.001, B =  - 4.84). Patients with severe COVID-19 had lower HRQOL compared to those with a non-severe level. It is necessary to consider implementing policies aimed at providing social, psychological, or medical support to improve the HRQOL of patients with a history of severe COVID-19.

The Association of Smell and Taste Dysfunction with COVID19, And Their Functional Impacts

The novel coronavirus disease 2019 (COVID-19), which caused Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was appeared at the end of 2019 in wuhan city in china. Covid-19 has high ability of transmission from human to another human, and due to its fast spread globally, the World Health Organization (WHO) announced that Covid-19 is pandemic disease on March 11, 2020. Several articles have reported many common ENT-related symptoms as an early sign of COVID19. To measure the prevalence of insomnia and dysgeusia in COVID19 patients in Saudi Arabia and investigate their functional and psychological effects on patients. This study evaluated the impact of insomnia and dysgeusia on COVID-19 patients' quality of life using the short version of the Olfactory Disorders-Negative Statements (sQODNS) Questionnaire. It was done from 5 June to 30 July 2020, in the Eastern region of Saudi Arabia. A total of 274 laboratory-confirmed COVID-19 patients were participated. The most common ENT-related symptoms were headache 69%, insomnia 65.3%, and dysgeusia 64.6%. Interestingly, insomnia can greatly affect patients' daily life, as around 37.6% of our patients had problems with taking part in daily activities, 42% felt isolated, 68.1% had changes in appetite, 51.4% had more stress, and 28.2% had increased anger secondary to loss of smell. In Addition, 62% (110) of patients who lost their taste declared that their daily activities were affected. ENT-related symptoms are one of the most COVID19 manifestations. The duration of both insomnia and dysgeusia is an important contributing factor on the patients' functional & psychological state as it may prolong their isolation period. Therefore, Otolaryngologists considered the first-line physicians for many of Covid-19 patients, which makes us at higher risk to be infected with Covid-19 too. It is also particularly important for Otolaryngologists to develop a management guideline to reduce the duration and severity of all ENT-related features.

High Seroprevalence of SARS-CoV-2 in Mwanza, Northwestern Tanzania: A Population-Based Survey

The transmission of the SARS-CoV-2 virus, which causes COVID-19, has been documented worldwide. However, the evidence of the extent to which transmission has occurred in different countries is still to be established. Understanding the magnitude and distribution of SARS-CoV-2 through seroprevalence studies is important in designing control and preventive strategies in communities. This study investigated the seropositivity of the SARS-CoV-2 virus antibodies in the communities of three different districts in the Mwanza region, Tanzania. A household cross-sectional survey was conducted in September 2021 using the modified African Centre for Disease and Prevention (ACDC) survey protocol. A blood sample was obtained from one member of each of the selected households who consented to take part in the survey. Immunochromatographic rapid test kits were used to detect IgM and IgG SARS-CoV-2 antibodies, followed by descriptive data analysis. Overall, 805 participants were enrolled in the study with a median age of 35 (interquartile range (IQR):27-47) years. The overall SARS-CoV-2 seropositivity was 50.4% (95%CI: 46.9-53.8%). The IgG and IgM seropositivity of the SARS-CoV-2 antibodies was 49.3% and 7.2%, respectively, with 6.1% being both IgG and IgM seropositive. A history of runny nose (aOR: 1.84, 95%CI: 1.03-3.5, p = 0.036), loss of taste (aOR: 1.84, 95%CI: 1.12-4.48, p = 0.023), and living in Ukerewe (aOR: 3.55, 95%CI: 1.68-7.47, p = 0.001) and Magu (aOR: 2.89, 95%CI: 1.34-6.25, p= 0.007) were all independently associated with SARS-CoV-2 IgM seropositivity. Out of the studied factors, living in the Ukerewe district was independently associated with IgG seropositivity (aOR 1.29, CI 1.08-1.54, p = 0.004). Twenty months after the first case of COVID-19 in Tanzania, about half of the studied population in Mwanza was seropositive for SARS-CoV-2.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies: relationship with COVID-19 diagnosis, symptoms, smoking, and method of transmission

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The most discriminating symptom of COVID-19 by far was the loss of smell/taste.

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In smokers, the incidence of positive COVID-19 diagnoses was significantly lower.

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There was a discrepancy between COVID-19 diagnosis and the presence of IgG antibodies.

Aims

The study of SARS-CoV-2 antibodies in the population is a crucial step towards overcoming the COVID-19 pandemic. Seroepidemiological studies allow an estimation of the number of people who have been exposed to the virus, as well as the number of people who are still susceptible to infection.

Methods

In total, 13 560 people from Arganda del Rey, Madrid (Spain) were assessed between January and March 2021 for the presence of IgG antibodies, using rapid tests and histories of symptoms compatible with COVID-19.

Results

24.2% of the participants had IgG antibodies and 9% had a positive COVID-19 diagnosis. Loss of smell/taste was the most discriminating symptom of the disease. The main transmitters of infection were found to be household members. Unexpectedly, in smokers, the incidence of positive COVID-19 diagnoses was significantly lower. Additionally, it was found that there was a discrepancy between COVID-19 diagnosis and the presence of IgG antibodies.

Conclusions

Rapid anti-IgG tests are less reliable in detecting SARS-CoV-2 infection at an individual level, but are functional in estimating SARS-CoV-2 infection rates at an epidemiological level. The loss of smell/taste is a potential indicator for establishing COVID-19 infection.

SARS-CoV-2 Infection (COVID-19) and Rhinologic Manifestation: Narrative Review

Patients with severe pneumonia of unknown etiology presented in December 2019 in Wuhan, China. A novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was isolated from the respiratory tracts of these patients. The World Health Organization (WHO) defined respiratory diseases due to SARS-CoV-2 infection as coronavirus disease 2019 (COVID-19). Many researchers have reported that the nasal cavity is an important initial route for SARS-CoV-2 infection and that the spike protein of this virus binds to angiotensin-converting enzyme 2 (ACE2) on epithelial cell surfaces. Therefore, COVID-19 is thought to significantly affect nasal symptoms and various rhinological diseases. In this review, we summarize the association between COVID-19 and various rhinological diseases, such as olfactory dysfunction, rhinosinusitis, and allergic rhinitis.

Impact of the COVID-19 pandemic on dental hygiene students in the Italian region of Emilia-Romagna

BACKGROUND

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new coronavirus detected in China at the end of 2019. Because SARS-CoV-2 is highly infectious due to contamination in the air, there is a high risk of infection in the dental environment which is represents a serious problem for professionals and students (dentistry and dental hygiene). In Italy, since February 23, 2020, the government has suspended all teaching activities of schools and universities.

METHODS

An anonymous questionnaire was administered to the students of the degree courses in Dental Hygiene of the Emilia Romagna Region, one of the most affected regions in Italy. The survey was intended to highlight the practical and emotional consequences of the emergency of COVID-19 on educational activities and in the training of students.

RESULTS

The survey was sent to the 150 students enrolled in the universities of Bologna, Ferrara and Modena and Reggio Emilia; 141 of them completed it (94%). Since the start of the COVID-19 pandemic, several surveys have been proposed to measure the impact of this emergency situation on dental professionals; at present, however, there are still no assessments for dental hygiene degree courses, in particular aimed at assessing the psychological impact on students.

CONCLUSIONS

Students consider the dental hygienist as a risky profession, while the risk taken by patients is considered as low. Given the concern reported the students, it would be useful to address the issue of proper assessment of risk during the university training of dental hygienists.

Role of SARS-CoV-2 in Modifying Neurodegenerative Processes in Parkinson's Disease: A Narrative Review

The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact global health regarding both morbidity and mortality. Although SARS-CoV-2 primarily causes acute respiratory distress syndrome (ARDS), the virus interacts with and influences other organs and tissues, including blood vessel endothelium, heart, gastrointestinal tract, and brain. We are learning much about the pathophysiology of SARS-CoV-2 infection; however, we are just beginning to study and understand the long-term and chronic health consequences. Since the pandemic's beginning in late 2019, older adults, those with pre-existing illnesses, or both, have an increased risk of contracting COVID-19 and developing severe COVID-19. Furthermore, older adults are also more likely to develop the neurodegenerative disorder Parkinson's disease (PD), with advanced age as the most significant risk factor. Thus, does SARS-CoV-2 potentially influence, promote, or accelerate the development of PD in older adults? Our initial focus was aimed at understanding SARS-CoV-2 pathophysiology and the connection to neurodegenerative disorders. We then completed a literature review to assess the relationship between PD and COVID-19. We described potential molecular and cellular pathways that indicate dopaminergic neurons are susceptible, both directly and indirectly, to SARS-CoV-2 infection. We concluded that under certain pathological circumstances, in vulnerable persons-with-Parkinson's disease (PwP), SARS-CoV-2 acts as a neurodegenerative enhancer to potentially support the development or progression of PD and its related motor and non-motor symptoms.

Olfactory and gustatory disorders caused by COVID-19: How to regain the pleasure of eating?

Background

Recently, anosmia and ageusia (and their variations) have been reported as frequent symptoms of COVID-19. Olfactory and gustatory stimuli are essential in the perception and pleasure of eating. Disorders in sensory perception may influence appetite and the intake of necessary nutrients when recovering from COVID-19. In this short commentary, taste and smell disorders were reported and correlated for the first time with food science.

Scope and approach

The objective of this short commentary is to report that taste and smell disorders resulted from COVID-19 may impact eating pleasure and nutrition. It also points out important technologies and trends that can be considered and improved in future studies.

Key findings and conclusions

Firmer food textures can stimulate the trigeminal nerve, and more vibrant colors are able to increase the modulation of brain metabolism, stimulating pleasure. Allied to this, encapsulation technology enables the production of new food formulations, producing agonist and antagonist agents to trigger or block specific sensations. Therefore, opportunities and innovations in the food industry are wide and multidisciplinary discussions are needed.

Clinical correlation and assessment of olfactory dysfunction with n-butanol in COVID-19 patients: our experience

Background: Studies showed olfactory disturbances in COVID patients. This has attracted focus of clinicians as an easy clinical screening tool in suspected population. Material and methods: 70 mild and moderate category COVID-19 RT-PCR positive patients, more than 10 years of age were tested on day of admission for olfaction with serial dilution of n-butanol and asked to grade severity of their olfactory dysfunction according to visual analogue score from 1-10. Results: Fatigue 42 (93.33%), sore throat 37 (82.22%), fever 36 (80%) and dyspnea 23 (51.11%) were the most common symptoms in moderate patients. Diabetes, hypertension and allergy were the three prominent risk factors. At time of admission, n-butanol diagnosed 20 patients having olfactory dysfunction compared to 11 by VAS. Patients tend to grade their dysfunction higher on VAS whereas the n-butanol test classified their olfactory dysfunction lower. Viral load and high CRP were not found to be significantly related with olfactory dysfunction. d-Dimer and LDH levels were found statistically associated with higher grading of olfactory dysfunction detected by n-butanol. Conclusion: The majority of cases developed hyposmia before they were admitted to hospital even before they realized that they were having hyposmia as revealed by n-butanol testing. We should go for objective tests of olfaction.

Zinc deficiency as a possible risk factor for increased susceptibility and severe progression of Corona Virus Disease 19

The importance of Zn for human health becomes obvious during Zn deficiency. Even mild insufficiencies of Zn cause alterations in haematopoiesis and immune functions, resulting in a proinflammatory phenotype and a disturbed redox metabolism. Although immune system malfunction has the most obvious effect, the functions of several tissue cell types are disturbed if Zn supply is limiting. Adhesion molecules and tight junction proteins decrease, while cell death increases, generating barrier dysfunction and possibly organ failure. Taken together, Zn deficiency both weakens the resistance of the human body towards pathogens and at the same time increases the danger of an overactive immune response that may cause tissue damage. The case numbers of Corona Virus Disease 19 (COVID-19) are still increasing, which is causing enormous problems for health systems and economies. There is an urgent need to reduce both the number of severe cases and the resulting deaths. While therapeutic options are still under investigation, and first vaccines have been approved, cost-effective ways to reduce the likelihood of or even prevent infection, and the transition from mild symptoms to more serious detrimental disease, are highly desirable. Nutritional supplementation might be an effective option to achieve these aims. In this review, we discuss known Zn deficiency effects in the context of an infection with Severe Acute Respiratory Syndrome-Coronavirus-2 and its currently known pathogenic mechanisms and elaborate on how severe pre-existing Zn deficiency may pre-dispose patients to a severe progression of COVID-19. First published clinical data on the association of Zn homoeostasis with COVID-19 and registered studies in progress are listed.

Self-reported olfactory and gustatory dysfunctions in COVID-19 patients: a 1-year follow-up study in Foggia district, Italy

BACKGROUND

From the initial stages of the pandemic in early 2020, COVID-19-related olfactory and gustatory dysfunctions have been widely reported and are emerging as one of the most frequent long-term sequelae of SARS-CoV-2 infection. However, data regarding the long-term recovery of the sense of smell and taste are lacking. This study aimed to characterize the evolution up to one year after the diagnosis of self-reported olfactory and gustatory dysfunctions in COVID-19 cases.

METHODS

Based on the data of the active surveillance platform of the Apulia region, Italy, we selected the residents of Foggia district who were confirmed positive for SARS-CoV-2 from March 1st to June 16th, 2020, and home-quarantined with paucisymptomatic-to-mild clinical presentation. Self-reported olfactory and gustatory dysfunctions were recorded at baseline through a survey of dichotomous questions. The evolution of these symptoms at approximately one year was prospectively assessed via telephone by the validated sino-nasal outcome test 22 (SNOT-22, Italian version).

RESULTS

Among the 1,175 COVID-19 cases notified in the Foggia district during the first epidemic wave, 488 had paucisymptomatic-to-mild clinical presentation. Of these, 41.2% (n = 201, 95% confidence interval [CI] 36.8-45.7%) reported at least one sensory dysfunction. A total of 178 to 201 (88.5%) patients agreed to participate in the follow-up survey. According to the SNOT-22 results, the persistence of a sensory dysfunction was observed in the 29.8% (n = 53, 95% CI 23.2-37.1%) of them. Particularly, loss of smell persisted in 25.8% (n = 46, 95% CI 19.6-32.9%), loss of taste in 21.3% (n = 38, 95% CI 15.6-28.1%), loss of both in 17.4% (n = 31, 95% CI 12.2-23.8%) of participants in the follow-up. The rates of full recovery increased over time: from 59% at 30 days to 71.9% at 90 days for the sense of smell; from 61.3% at 30 days to 74.7% at 90 days for the sense of taste.

CONCLUSIONS

The persistence of COVID-19-related olfactory and gustatory dysfunctions up to 12 months after the disease onset in a noteworthy proportion (approximately 3 out of 10) of patients with paucisymptomatic-to-mild clinical presentation deserves further investigations due to its possible pathophysiological implications and impact on the quality of life.

Subjective Mouthfeel and Temperature Alterations in COVID-19 Patients Six to Ten Months After Diagnosis

Introduction

The characteristics and impact of mouthfeel, temperature, smell, and taste alterations in patients with COVID-19 at a long term are yet not well known. In this study, these characteristics and their impact on daily life and quality of life (QoL) were assessed, six to ten months after infection, in patients with COVID-19 searching for peer support on Facebook.

Methods

Between December 2020 and January 2021, members of two COVID-19 Facebook groups were invited to complete a questionnaire. Participants were asked to report their perception of mouthfeel, temperature, smell, and taste alterations and their impact.

Results

The questionnaire was completed by 157/216 respondents (73%), with 92% being women. Alterations in mouthfeel, temperature, smell, and taste were reported by respectively 66, 40, 148, and 133 participants. The most frequently reported mouthfeel alterations were "a different feeling" and "dry mouth" in 38 and 30 participants, respectively. Preferences for food temperature were equally changed to "freezing", "cool", "room temperature", "a bit warmer", and "warmer". An impact on daily life and QoL was reported by most patients with alterations in mouthfeel (91% and 79%), temperature (78% and 60%), smell (98% and 93%), and taste (93% and 88%), respectively.

Conclusions

Patients with COVID-19 searching for peer support on Facebook experienced, next to smell and taste alterations, mouthfeel and temperature disturbances, six to ten months after infection. These alterations have an impact on daily life and QoL.

Implications

Health professionals should, next to smell and taste alterations, be aware of mouthfeel and temperature alterations in patients with COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12078-022-09304-y.

Risk factors for mental health in general population during SARS-COV2 pandemic: a systematic review

The COVID-19 pandemic and its social restrictions have affected mental health globally. This systematic review aims to analyze the psychological responses of the general population and its related sociodemographic risk factors, excluding the most vulnerable groups (e.g., healthcare workers, COVID-19 patients and survivors, pregnant women, people with chronic diseases or preexisting psychiatric disorders). A reproducible search from June 2020 to February 2021 was conducted on PubMed and Google Scholar, following the PRISMA guidelines. Papers that (1) considered the most at-risk populations, (2) did not report sociodemographic data, and (3) did not use validated scales were excluded from our analysis. Non-English papers and review articles were also excluded. Of 1116 papers identified, 25 were included for this review (n = 162,465). The main risk factors associated with the emergence of depression, anxiety, sleep disorders, post-traumatic stress disorder, and obsessive compulsive disorder were: female gender, younger and later age, high level of education, Latino origin, free marital status, living quarantine in a house with no outdoor, negative coping strategies, close proximity to positive cases, high concern about contracting COVID-19 and living in a most affected area. High income, physical activity, resilience, family support, and a high level of knowledge about COVID-19, seems to be protective factors against the onset of psychological symptoms. In a general population, COVID-19 restrictions are linked to risk factors for psychological disorders caused by gender and sociodemographic conditions. In this regard governments should pay more attention to the public’s mental health and its risk and protective factors.

Obesity and the increased risk for COVID-19: mechanisms and nutritional management

The global COVID-19 (coronavirus disease 2019) pandemic has become a complex problem that overlaps with a growing public health problem, obesity. Obesity alters different components of the innate and adaptive immune responses, creating a chronic and low-grade state of inflammation. Nutritional status is closely related to a better or worse prognosis of viral infections. Excess weight has been recognised as a risk factor for COVID-19 complications. In addition to the direct risk, obesity triggers other diseases such as diabetes and hypertension, increasing the risk of severe COVID-19. The present review explains the diets that induce obesity and the importance of different foods in this process. We also review tissue disruption in obesity, leading to impaired immune responses and the possible mechanisms by which obesity and its co-morbidities increase COVID-19 morbidity and mortality. Nutritional strategies that support the immune system in patients with obesity and with COVID-19 are also discussed in light of the available data, considering the severity of the infection. The discussions held may contribute to combating this global emergency and planning specific public health policy.

Brain injury, endothelial injury and inflammatory markers are elevated and express sex-specific alterations after COVID-19

Objective

Although COVID-19 is a respiratory disease, all organs can be affected including the brain. To date, specific investigations of brain injury markers (BIM) and endothelial injury markers (EIM) have been limited. Additionally, a male bias in disease severity and mortality after COVID-19 is evident globally. Sex differences in the immune response to COVID-19 may mediate this disparity. We investigated BIM, EIM and inflammatory cytokine/chemokine (CC) levels after COVID-19 and in across sexes.

Methods

Plasma samples from 57 subjects at < 48 h of COVID-19 hospitalization, and 20 matched controls were interrogated for the levels of six BIMs—including GFAP, S100B, Syndecan-1, UCHLI, MAP2 and NSE, two EIMs—including sICAM1 and sVCAM1. Additionally, several cytokines/chemokines were analyzed by multiplex. Statistical and bioinformatics methods were used to measure differences in the marker profiles across (a) COVID-19 vs. controls and (b) men vs. women.

Results

Three BIMs: MAP2, NSE and S100B, two EIMs: sICAM1 and sVCAM1 and seven CCs: GRO IL10, sCD40L, IP10, IL1Ra, MCP1 and TNFα were significantly (p < 0.05) elevated in the COVID-19 cohort compared to controls. Bioinformatics analysis reveal a stronger positive association between BIM/CC/EIMs in the COVID-19 cohort. Analysis across sex revealed that several BIMs and CCs including NSE, IL10, IL15 and IL8 were significantly (p < 0.05) higher in men compared to women. Men also expressed a more robust BIM/ EIM/CC association profile compared to women.

Conclusion

The acute elevation of BIMs, CCs, and EIMs and the robust associations among them at COVID-19 hospitalization are suggestive of brain and endothelial injury. Higher BIM and inflammatory markers in men additionally suggest that men are more susceptible to the risk compared to women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12974-021-02323-8.

Pain and Other Neurological Symptoms Are Present at 3 Months After Hospitalization in COVID-19 Patients

COVID-19 is an ongoing pandemic with a devastating impact on public health. Acute neurological symptoms have been reported after a COVID-19 diagnosis, however, the long-term neurological symptoms including pain is not well established. Using a prospective registry of hospitalized COVID-19 patients, we assessed pain and neurological function (including functional, cognitive and psychiatric assessments) of several hospitalized patients at 3 months. Our main finding is that 60% of the patients report pain symptoms. 71% of the patients still experienced neurological symptoms at 3 months and the most common symptoms being fatigue (42%) and PTSD (25%). Cognitive symptoms were found in 12%. Our preliminary findings suggests the importance of investigating long-term outcomes and rationalizes the need for further studies investigating the neurologic outcomes and symptoms of pain after COVID-19.

Performance of COVID-19 associated symptoms and temperature checking as a screening tool for SARS-CoV-2 infection

INTRODUCTION

Coronavirus disease-19 (COVID-19), which started in late December, 2019, has spread to affect 216 countries and territories around the world. Globally, the number of cases of SARS-CoV-2 infection has been growing exponentially. There is pressure on countries to flatten the curves and break transmission. Most countries are practicing partial or total lockdown, vaccination, massive education on hygiene, social distancing, isolation of cases, quarantine of exposed and various screening approaches such as temperature and symptom-based screening to break the transmission. Some studies outside Africa have found the screening for fever using non-contact thermometers to lack good sensitivity for detecting SARS-CoV-2 infection. The aim of this study was to determine the usefulness of clinical symptoms in accurately predicting a final diagnosis of COVID-19 disease in the Ghanaian setting.

METHOD

The study analysed screening and test data of COVID-19 suspected, probable and contacts for the months of March to August 2020. A total of 1,986 participants presenting to Tamale Teaching hospital were included in the study. Logistic regression and receiver operator characteristics (ROC) analysis were carried out.

RESULTS

Overall SARS-CoV-2 positivity rate was 16.8%. Those with symptoms had significantly higher positivity rate (21.6%) compared with asymptomatic (17.0%) [chi-squared 15.5, p-value, <0.001]. Patients that were positive for SARS-CoV-2 were 5.9 [3.9-8.8] times more likely to have loss of sense of smell and 5.9 [3.8-9.3] times more likely to having loss of sense of taste. Using history of fever as a screening tool correctly picked up only 14.8% of all true positives of SARS-CoV-2 infection and failed to pick up 86.2% of positive cases. Using cough alone would detect 22.4% and miss 87.6%. Non-contact thermometer used alone, as a screening tool for COVID-19 at a cut-off of 37.8 would only pick 4.8% of positive SARS-CoV-2 infected patients.

CONCLUSION

The use of fever alone or other symptoms individually [or in combination] as a screening tool for SARS-CoV-2 infection is not worthwhile based on ROC analysis. Use of temperature check as a COVID-19 screening tool to allow people into public space irrespective of the temperature cut-off is of little benefit in diagnosing infected persons. We recommend the use of facemask, hand hygiene, social distancing as effective means of preventing infection.

The perceived impact of the COVID-19 pandemic on dental undergraduate students in the Italian region of Emilia-Romagna

INTRODUCTION

The outbreak and diffusion of the novel SARS-CoV2 coronavirus have caused an emergency status in the dental education system.

MATERIALS AND METHODS

An anonymous survey composed of 34 questions was delivered to students of the Master Degree Programme in Dentistry and Dental Prosthodontics of the Universities of Emilia-Romagna, the fifth Italian region most affected by the pandemic. The psychological impact of COVID-19 was assessed by means of the Generalised Anxiety Disorder-7 scale (GAD-7). Numerically recoded data were analysed using the Analysis of Variance (ANOVA), whilst to investigate the association between quantitative variables, the Pearson correlation coefficient (R) was computed.

RESULTS

The questionnaire was completed by 399 students (75%) out of 532. Most students experienced difficulties in working at the thesis during the COVID-19 emergency. For over half of them, online teaching could only partially replace traditional face-to-face lessons. The negative impact on the study career was judged as particularly high by sixth-year students. Clinical training activities were considered as exposing to the risk of contracting COVID-19 infection by the majority of the students. The level of concern of contracting COVID-19 infections during future university activities was positively correlated to risk perception related to clinical training.

CONCLUSION

The results of this survey could be used to train students to a correct risk assessment. Students reported experiencing concern whilst thinking of COVID-19 and 6.5% of them showed symptoms related to high levels of anxiety. These data may guide Universities in trying to reduce students' anxiety by means of correct communication strategies.

Magnetic resonance neurography findings in three critically ill COVID-19 patients with new onset of extremity peripheral neuropathy

Purpose

Coronavirus-19 (COVID-19) is most commonly associated with respiratory syndromes, although patients are presenting more frequently with neurological symptoms. When they occur, neurological conditions most commonly involve the central nervous system, and peripheral nervous system effects, particularly in the extremities, have been less commonly described. The mechanisms of peripheral neuropathy in critically ill patients with COVID-19 are likely to be multifactorial, and extremity peripheral nerve imaging in these cases has not been well described.

Case presentation

In this case series, we describe the magnetic resonance neurography (MRN) findings in 3 critically ill patients who presented with new onset of peripheral neuropathies in the extremities, and we discuss possible common mechanisms of nerve injury, including the role of position-related nerve injury.

Conclusions

MRN can be useful in identifying and localizing peripheral nerve abnormalities in the extremities of COVID-19 patients, and patients who are placed in the prone position during ventilation may be more susceptible to these injuries.

Cognitive Impairment After COVID-19-A Review on Objective Test Data

Objective: The aim was to conduct a review on the literature on objective cognitive impairment in patients after COVID-19. Methods: We performed a literature review and searched Ovid Medline in February 2021 based on a PECO scheme. Results: Twelve articles met all inclusion criteria. Total patient sample was <1,000. All studies on global cognitive function found impairment, ranging from 15 to 80% of the sampled patients. Seven studies on attention and executive functions reported impairment, with varying results depending on sub-domain and different tests. Three out of four studies reported memory difficulties, with two studies reporting short-term memory deficits. Although results indicate possible language impairment, only one study used domain-specific language tasks. Two out of four studies on visuospatial function did not report any impairment. Conclusion: Patients with recent SARS-CoV-2 infection appear to experience global cognitive impairment, impairment in memory, attention and executive function, and in particular verbal fluency. Based on the current results, we recommend clinicians to evaluate the need for cognitive assessment of patients with a recent COVID-19 infection, regardless of the severity of the disease, treatment methods and length of ICU stay. We need studies with larger sample and control group.

Anosmia but Not Ageusia as a COVID-19-Related Symptom among Cancer Patients-First Results from the PAPESCO-19 Cohort Study

Background: Cancer patients may fail to distinguish COVID-19 symptoms such as anosmia, dysgeusia/ageusia, anorexia, headache, and fatigue, which are frequent after cancer treatments. We aimed to identify symptoms associated with COVID-19 and to assess the strength of their association in cancer and cancer-free populations. Methods: The multicenter cohort study PAPESCO-19 included 878 cancer patients and 940 healthcare workers (HCWs). At baseline and quarterly thereafter, they reported the presence or absence of 13 COVID-19 symptoms observed over 3 months and the results of routine screening RT-PCR, and they were systematically tested for SARS-CoV-2-specific antibodies. We identified the symptom combinations significantly associated with COVID-19. Results: Eight percent of cancer patients were COVID-19 positive, and 32% were symptomatic. Among the HCWs, these proportions were 9.5 and 52%, respectively. Anosmia, anorexia, fever, headache, and rhinorrhea together accurately discriminated (c-statistic = 0.7027) COVID-19 cases from cancer patients. Anosmia, dysgeusia/ageusia, muscle pain, intense fatigue, headache, and chest pain better discriminated (c-statistic = 0.8830) COVID-19 cases among the HCWs. Anosmia had the strongest association in both the cancer patients (OR = 7.48, 95% CI: 2.96-18.89) and HCWs (OR = 5.71, 95% CI: 2.21-14.75). Conclusions: COVID-19 symptoms and their diagnostic performance differ in the cancer patients and HCWs. Anosmia is associated with COVID-19 in cancer patients, while dysgeusia/ageusia is not. Cancer patients deserve tailored preventive measures due to their particular COVID-19 symptom pattern.

Characterization of the SARS-CoV-2 E Protein: Sequence, Structure, Viroporin, and Inhibitors

The COVID-19 epidemic is one of the most influential epidemics in history. Understanding the impact of coronaviruses (CoVs) on host cells is very important for disease treatment. The SARS-CoV-2 envelope (E) protein is a small structural protein involved in many aspects of the viral life cycle. The E protein promotes the packaging and reproduction of the virus, and deletion of this protein weakens or even abolishes the virulence. This review aims to establish new knowledge by combining recent advances in the study of the SARS-CoV-2 E protein and by comparing it with the SARS-CoV E protein. The E protein amino acid sequence, structure, self-assembly characteristics, viroporin mechanisms and inhibitors are summarized and analyzed herein. Although the mechanisms of the SARS-CoV-2 and SARS-CoV E proteins are similar in many respects, specific studies on the SARS-CoV-2 E protein, for both monomers and oligomers, are still lacking. A comprehensive understanding of this protein should prompt further studies on the design and characterization of effective targeted therapeutic measures.

Olfactory and taste disorders in healthcare workers with COVID-19 infection

PURPOSE

Severe acute respiratory syndrome caused by COVID-19 has spread globally for the last few months. Healthcare workers (HCW) are overexposed and infection rates are higher than in the rest of the population. Strict clinical assessment is paramount to detect suspicious cases. In this context, olfactory or taste dysfunction (OTD) appears as an early and frequent symptom. Evaluating its presence in early stages plays an important role nowadays.

METHODS

We performed a descriptive observational single-center study among 256 HCW at Hospital Universitario de Fuenlabrada affected by COVID-19 and confirmed using RT-PCR. A telephonic interview was performed, after obtaining oral informed consent.

RESULTS

OTD was present in up to 70% of the cases as an early symptom, including mild-to-severe cases. The extent of these sensory deficits lasted an average of 11 days. In 26% of the patients, these sensory alterations persisted for over a month.

CONCLUSION

OTD is reported as an early symptom among HCW with SARS-CoV-2 infection. Its strong association with test positivity is useful in the management of the infection and should be enough to indicate preventive isolation. We consider that OTD needs to be included in clinical screening questionnaires in HCW.

Investigation on the Loss of Taste and Smell and Consequent Psychological Effects: A Cross-Sectional Study on Healthcare Workers Who Contracted the COVID-19 Infection

The aim of this study was to investigate the correlation between psychological distress and taste and sense of smell dysfunctions on healthcare workers (HCW) who contracted the COVID-19 infection in the midst of the disease outbreak. Reports of sudden loss of taste and smell which persist even after recovery from COVID-19 infection are increasingly recognized as critical symptoms for COVID-19 infections. Therefore, we conducted a cross-sectional study on COVID-19 HCW (N = 104) who adhered to respond to a phone semistructured interview addressing the virus symptoms and associated psychological distress. Data were collected from June to September 2020. Findings confirm the association between experienced taste/olfactory loss and emotional distress and suggest that dysfunctions of taste and smell correlate positively with anxiety and depression. Furthermore, their psychological impact tends to persist even after the recovery from the disease, suggesting the need for appropriate psychological interventions to prevent people from developing more serious or long-lasting psychological disorders and, as far as HCW, to reduce the risk of work-related distress.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

I.

EXECUTIVE SUMMARY

BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document.

METHODS

ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary.

RESULTS

ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided.

CONCLUSION

This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

Chemosensory Systems in COVID-19: Evolution of Scientific Research

COVID-19 disease induced by coronavirus SARS-CoV-2 presents among its symptoms alterations of the chemosensory functions. In the first studies on the Chinese population, this symptomatology was not particularly relevant, and hyposmia and hypogeusia were excluded from the symptoms to be evaluated to diagnose the disease. With the pandemic spread of the illness, there has been an augment in reports on chemosensory dysfunctions among patients. The first data analysis showed the presence of these disorders mainly in paucisymptomatic and asymptomatic patients. The interest in chemosensory systems therefore increased considerably, because the olfactory and gustatory symptoms could be the key to stop the infection spread. Furthermore, the degree of alert and attention grew, considering that these types of dysfunctions are prognostic symptoms of serious neurodegenerative diseases. About 9 months have passed since the first anecdotal reports on the involvement of the olfactory and gustatory systems in the COVID-19 pathology. For this reason, a careful review of the literature was conducted to understand if it is clearer which people present chemosensory symptoms and if these are related to the severity of the disease. Furthermore, we have identified which aspects still remain to be clarified.

COVID-19 (SARS-CoV-2) in Non-Airborne body fluids: A systematic review & Meta-analysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been predominantly respiratory. This study aimed to evaluate the presence of virus in non-airborne body fluids as transmission vehicles. Medline, EMBASE, and Cochrane Library databases were searched from December 01, 2019, to July 01, 2020, using terms relating to SARS-CoV-2 and non-airborne clinical sample sources (feces, urine, blood, serum, serum, and peritoneum). Studies in humans, of any design, were included. Risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy 2 tool. Preferred Reporting Items for Systematic Reviews & Meta-Analyses) guidelines were used for abstracting data. If ≥5 studies reported proportions for the same non-respiratory site, a meta-analysis was conducted using either a fixed or random-effects model, depending on the presence of heterogeneity. A total of 22 studies with 648 patients were included. Most were cross-sectional and cohort studies. The SARS-CoV-2 RNA was most frequently detected in feces. Detectable RNA was reported in 17% of the blood samples, 8% of the serum, 16% in the semen, but rarely in urine. Prevalence of SARS-CoV-2 in non-airborne sites varies widely with a third of non-airborne fluids. Patients with bowel and non-specific symptoms have persistence of virus in feces for upto 2 weeks after symptom resolution. Although there was a very low detection rate in urine, given the more frequent prevalence in blood samples, the presence of SARS-CoV-2 in patients with disrupted urothelium or undergoing urinary tract procedures, is likely to be higher. Healthcare providers need to consider non-airborne transmission and persistence of SARS-CoV-2 in body fluids to enable appropriate precautions to protect healthcare workers and carers.

Onset and duration of symptoms of loss of smell/taste in patients with COVID-19: A systematic review

Objective

The aim of the study was to conduct a systematic review of the literature to investigate the time of onset and duration of symptoms of loss of smell and taste in patients diagnosed with COVID-19.

Methods

Two independent authors performed a systematic review of the Medline/PubMed, SCOPUS, COCHRANE, Lilacs and Web of Science electronic databases. The time of onset and duration of symptoms were considered primary outcomes. The sex and age of individuals, the geographical location of the study, the prevalence of symptoms, other associated symptoms, associated comorbidities, and the impact on quality of life and eating habits were considered secondary outcomes.

Results

Our search generated 17 articles. Many of the studies reported that the onset of anosmia and ageusia occurred 4 to 5 days after the manifestation of other symptoms of the infection and that these symptoms started to disappear after one week, with more significant improvements in the first two weeks.

Conclusion

The present study concludes that the onset of symptoms of loss of smell and taste, associated with COVID-19, occurs 4 to 5 days after other symptoms, and that these symptoms last from 7 to 14 days. Findings, however, varied and there is therefore a need for further studies to clarify the occurrence of these symptoms. This would help to provide early diagnosis and reduce contagion by the virus.

Olfactory and Gustatory Dysfunction in COVID-19 Patients from Northern India: A Cross-Sectional Observational Study

Olfactory dysfunction (OD) and gustatory dysfunction (GD) has been reported as one of the presenting symptoms amongst COVID-19 patients. However the literature available is disjunct on this aspect. This study is conducted to identify the prevalence of olfactory and/or gustatory dysfunction in patients with coronavirus disease in Northern part of India. It’s a cross-sectional observation study, conducted over 387 COVID-19 positive patients, at ENT dept of tertiary care hospital. A retrospective survey was conducted using a pre designed questionnaire and details of Olfactory and Gustatory dysfunction was collected. The patient’s demographic details, disease course and recovery time for olfactory (OD) and/or gustatory dysfunctions (GD) were collected. A total of 387 patients with COVID-19 completed the study. 228 (58.9%) patients suffered from influenza like illness (ILI) (fever, sore throat, dry cough, malaise, and myalgia). There was significant positive association seen between with ILI and OD and / or GD. 167/387 (43.15%) patients reported OD, and 153/387 (39.53%) reported GD. 43.71% and 50.3% patients had mild OD & GD respectively. Recovery rates for both OD and GD are high and almost similar, with 161 (96.4%) and 148 (96.73%) patients had complete recovery of smell and taste. Maximum recovery was noticed between 4 and 6 weeks. COVID-19 patients with habits have significantly high probability of developing OD &/or GD. There is a significant correlation between OD and GD and there is high probability that patients who reported to have OD will also have GD or vice versa. Prevalence of OD and GD in Indian population may not be as high as mentioned in western literature, however, both are frequent and early symptoms of COVID-19. Recent onset of these should be considered as red flag symptoms for COVID-19.

The Use of Antiviral Agents against SARS-CoV-2: Ineffective or Time and Age Dependent Result? A Retrospective, Observational Study among COVID-19 Older Adults

BACKGROUND

Our aim was to investigate the impact of therapeutics with antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on mortality of older adults affected by coronavirus disease 2019 (COVID-19), taking into consideration the time interval from symptoms onset to drugs administration.

METHODS

Data from 143 COVID-19 patients over 65 years of age admitted to the Humanitas Clinical and Research Center Emergency Department (Milan, Italy) and treated with Lopinavir/ritonavir (LPV/r) or Darunavir/cobicistat (DVR/c) associated to Hydroxychloroquine (HCQ) were retrospectively analyzed. Statistical analysis was performed by using a logistic regression model and survival analysis to assess the role of different predictors of in-hospital mortality, including an early (<6 days from symptoms onset) vs. late treatment onset, signs and symptoms at COVID-19 presentation, type of antiviral treatment (LPV/r or DVR/c) and patients' age (65-80 vs. >80 years old).

RESULTS

Multivariate analysis showed that an older age (OR: 2.54) and dyspnea as presenting symptom (OR: 2.01) were associated with higher mortality rate, whereas cough as presenting symptom (OR: 0.53) and a timely drug administration (OR: 0.44) were associated with lower mortality. Survival analysis demonstrated that the timing of drug administration had an impact on mortality in 65-80 years-old patients (p = 0.02), whereas no difference was seen in those >80 years-old. This impact was more evident in patients with dyspnea as primary symptom of COVID-19, in whom mortality decreased from 57.1% to 38.3% due to timely drug administration (OR: 0.5; p = 0.04).

CONCLUSIONS

There was a significant association between the use of a combined antiviral regimen and HCQ and lower mortality, when timely-administered, in COVID-19 patients aged 65-80 years. Our findings support timely treatment onset as a key component in the treatment of COVID-19.

Quick Olfactory Sniffin' Sticks Test (Q-Sticks) for the detection of smell disorders in COVID-19 patients

BACKGROUND

Coronavirus disease (COVID-19) infection represents a worldwide critical health burden from the sanitary perspective. This disease's symptoms range from a mild flu-like form to a severe life-threatening respiratory disease and respiratory failure. Several patients, however, remain paucisymptomatic. Among the symptoms that seem relevant are the changes in taste and smell, regardless of the disease's severity.

METHODS

Data from patients affected by COVID-19 infection, hospitalized from 15 to 29 April, 2020, were analyzed. Questionnaires about smell, taste, and nasal function were administered to all, and a proportion also received the Quick olfactory Sniffin' Sticks Test (q-Sticks) to objectivate the presence of anosmia or hyposmia. The results of instruments and Q-Sticks were then compared.

RESULTS

Thirty-seven patients (20 males, 54.1%), with a mean age 0f 69.19 years (SD = 17.96; median 76, IQR: 63-82) were evaluated. Among the patients, 8 (22%) were asymptomatic. Out of the remaining 29 patients, 28 (97%) had fever, 19 (66%) asthenia, 11 (38%) dry cough, 10 (34%) dyspnea, and 6 (21%) gastroenteric symptoms. The q-Sticks test was performed on 27 patients and showed that 6 with anosmia, and 16 patients had hyposmia, where only 5 (14%) patients complained of loss of smell by conducting the questionnaires.

CONCLUSION

Although olfactory disturbances may be secondary to other factors, a sudden onset of anosmia or hyposmia should be assessed as a possible symptom of COVID-19 infection. The use of questionnaires or anamnestic collection is sometimes not enough, while adding to them a simple test such as the q-Sticks test can provide more accurate and reliable data. A simple, easy-to-perform, and reliable tool (q-Sticks) for olfactory disorders assessment can be administered to identify the real size of anosmia in patients with COVID-19 infection and detect the early stage of infection or paucisymptomatic patients, therefore becoming important to reduce the spreading of the pandemic.

Radiation treatment of hemato-oncological patients in times of the COVID-19 pandemic : Expert recommendations from the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance

PURPOSE

The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care.

METHODS

A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally.

RESULTS

Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative).

CONCLUSION

RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.

Association of Salivary Content Alteration and Early Ageusia Symptoms in COVID-19 Infections: A Systematic Review

Coronavirus disease 2019 (COVID 19) is a major threat to the health and prosperity of human life at present. It has resulted in loss of thousands of lives globally and has brought countries to the brink of economic, social, and health collapse. A major issue of this infection is the ease with which it transmits through salivary droplets and its survival for long durations outside the body. Therefore, its early detection is critical in prevention, diagnostic, and management efforts of COVID-19 patients. Loss of taste and smell is one of the early symptoms reported in these patients and the virus is abundantly found in the salivary secretion of the infected symptomatic and asymptomatic patients. Infection and inflammation of salivary glands are common among viral infections, particularly in the early stages, which lead to salivary composition changes. Chemosensory sensation of taste is critically dependent on the salivary flow rate and its inorganic constituents, protein levels, specific 3',5'-cyclic adenosine monophosphate and 3',5'-cyclic guanosine monophosphate levels, ghrelins, pH levels, and enzymes. Therefore, the question arises, "Does COVID-19 infection alter the salivary components and composition leading to early transient symptoms of Ageusia and hypogeusia?" This review shows association of the COVID-19 and Ageusia, in addition to the early viral infection of salivary glands and possible changes in salivary flow and content. Therefore, suggesting a potential association between early ageusia in COVID-19 infection and salivary compositional changes.

Assessment of Smell and Taste Disorders in COVID-19: A Cross-sectional Study

BACKGROUND

It has been reported worldwide that patients with a diagnosis of COVID-19 usually suffer a loss of smell and taste. In this study, we aimed to evaluate the relationship between the severity of the disease and the loss of smell and taste. In addition, we evaluated patients' smell and taste functions after recovery.

METHODS

Between March and May 2020, 418 patients diagnosed with COVID-19 were divided into 3 groups: home-quarantined, hospitalized, and intensive care patients. The disease, smell, and taste functions of patients were evaluated with visual analog scores before diagnosis of COVID-19, during the disease, and fourth week after recovery. The types of smell loss and types of taste flavor loss occurring during the disease were questioned.

RESULTS

In all 3 groups, changes in smell and taste loss during the disease were statistically detected (P = 0.001). The smell loss rates determined in groups 1 to 3 were 45%, 43.7%, and 31.2%, respectively. The taste loss rates determined in groups 1 to 3were 46.6%, 32.1%, and 31.2% respectively. The rate of patients with a total recovery of smell loss in groups 1 to 3 were 95.5%, 93.7%, and 100%, respectively (P = 0.768). The rate of patients with a total recovery of taste loss in groups 1 to 3 were 97.1%, 91.4%, and 100%, respectively (P = 0.423).

CONCLUSION

COVID-19 causes significant loss of smell and taste in patients. The loss of smell and taste does not correlate with the severity of COVID-19 disease. The loss of smell and taste improves at a high rate after the disease.

Environmental Nanoparticles, SARS-CoV-2 Brain Involvement, and Potential Acceleration of Alzheimer's and Parkinson's Diseases in Young Urbanites Exposed to Air Pollution

Alzheimer's and Parkinson's diseases (AD, PD) have a pediatric and young adult onset in Metropolitan Mexico City (MMC). The SARS-CoV-2 neurotropic RNA virus is triggering neurological complications and deep concern regarding acceleration of neuroinflammatory and neurodegenerative processes already in progress. This review, based on our MMC experience, will discuss two major issues: 1) why residents chronically exposed to air pollution are likely to be more susceptible to SARS-CoV-2 systemic and brain effects and 2) why young people with AD and PD already in progress will accelerate neurodegenerative processes. Secondary mental consequences of social distancing and isolation, fear, financial insecurity, violence, poor health support, and lack of understanding of the complex crisis are expected in MMC residents infected or free of SARS-CoV-2. MMC residents with pre-SARS-CoV-2 accumulation of misfolded proteins diagnostic of AD and PD and metal-rich, magnetic nanoparticles damaging key neural organelles are an ideal host for neurotropic SARS-CoV-2 RNA virus invading the body through the same portals damaged by nanoparticles: nasal olfactory epithelium, the gastrointestinal tract, and the alveolar-capillary portal. We urgently need MMC multicenter retrospective-prospective neurological and psychiatric population follow-up and intervention strategies in place in case of acceleration of neurodegenerative processes, increased risk of suicide, and mental disease worsening. Identification of vulnerable populations and continuous effort to lower air pollution ought to be critical steps.

Attributes of dysgeusia and anosmia of coronavirus disease 2019 (COVID-19) in hospitalized patients

OBJECTIVES

While chemosensory dysfunctions, dysgeusia and anosmia/hyposmia, are recognized as distinctive symptoms of COVID-19, their temporality of presentation and association with the patient age, gender, disease severity, and comorbidities has been sparsely studied. Hence, we evaluated the latter associations of chemosensory dysfunction, in hospitalized COVID-19 patients in the United Arab Emirates (UAE).

MATERIALS AND METHODS

Information on chemosensory dysfunction and history of chronic systemic comorbidities, if any, was obtained from 149 COVID-19 patients in an infectious disease hospital in UAE, using their medical records, as well as from a face-to-face questionnaire survey. Additionally, a modified SNOT-22 questionnaire that measures disease-specific quality of life in patients with upper respiratory tract affections was also administered.

RESULTS

Chemosensory dysfunction was reported by 94.6% of the cohort, and anosmia with dysgeusia was significantly more in males than females with severe COVID-19. Males with moderate COVID-19 and systemic comorbidities were more likely to present with chemosensory dysfunction in comparison with females. SNOT-22 questionnaire revealed that nasal blockage and runny nose were more prevalent in mild/moderate, than in the severe, state of COVID-19.

CONCLUSION

Our data confirm the commonality of chemosensory dysfunction during COVID-19 progression, and the significantly more pronounced combined dysfunction in males with severe COVID-19, and comorbidities.

Using Anti-SARS-CoV-2 IgG and IgM Antibodies to Detect Outpatient Cases with Olfactory and Taste Disorders Suspected as Mild Form of COVID-19: a Retrospective Survey

Many patients with olfactory disorders were referred during the COVID-19 pandemic in 2020. The aim of this study was to detect outpatient cases with olfactory and taste disorders suspected to mild form of COVID-19 disease in Gorgan city in the north of Iran retrospectively. This study was performed on patients who had the complaints of olfactory disorders during 03/01/2020 to 04/01/2020. They also had the mild symptoms of upper respiratory tract infection. The control group included patients who had similar symptoms during this period but did not report olfactory or taste disturbances. Due to the limitations of serologic kits, this study was performed 2-3 months after the onset of symptoms. The number of patients and controls was 72 and 36 respectively. The range and the mean ± SD of patient's age were 21-63 and 39.82 ± 9.82 years. In both groups, 44.44% were male and 55.56% were female. The time interval between the onset of symptoms and the serologic tests in both groups was 91.11 ± 16.20 days. In the cases and controls, the IgG titer was positive in 44.4% and 22.2% and the IgM titer was positive in 5.6% and 8.3% respectively. IgG antibody titers were higher in cases than in the control group (P = 0.024). There was no correlation among antibody titers and the severity of olfactory disturbances, the gender, and the age. The high COVID-19 IgG antibody titer in patients with olfactory disorder during the pandemic can probably be considered as a warning complaint of COVID-19 and may be used for isolation plans.

Using Anti-SARS-CoV-2 IgG and IgM Antibodies to Detect Outpatient Cases with Olfactory and Taste Disorders Suspected as Mild Form of COVID-19: a Retrospective Survey

Many patients with olfactory disorders were referred during the COVID-19 pandemic in 2020. The aim of this study was to detect outpatient cases with olfactory and taste disorders suspected to mild form of COVID-19 disease in Gorgan city in the north of Iran retrospectively. This study was performed on patients who had the complaints of olfactory disorders during 03/01/2020 to 04/01/2020. They also had the mild symptoms of upper respiratory tract infection. The control group included patients who had similar symptoms during this period but did not report olfactory or taste disturbances. Due to the limitations of serologic kits, this study was performed 2–3 months after the onset of symptoms. The number of patients and controls was 72 and 36 respectively. The range and the mean ± SD of patient’s age were 21–63 and 39.82 ± 9.82 years. In both groups, 44.44% were male and 55.56% were female. The time interval between the onset of symptoms and the serologic tests in both groups was 91.11 ± 16.20 days. In the cases and controls, the IgG titer was positive in 44.4% and 22.2% and the IgM titer was positive in 5.6% and 8.3% respectively. IgG antibody titers were higher in cases than in the control group (P = 0.024). There was no correlation among antibody titers and the severity of olfactory disturbances, the gender, and the age. The high COVID-19 IgG antibody titer in patients with olfactory disorder during the pandemic can probably be considered as a warning complaint of COVID-19 and may be used for isolation plans.

Neurological Manifestations of COVID-19: A Case Report

A novel coronavirus disease (COVID-19) was reported in Wuhan, China in December 2019 and spread rapidly around the world, causing high rates of mortality and morbidity. This disease is known for its respiratory manifestations. Also, there have been several reports of neurological involvement in patients with COVID-19. In this study, we present a 55-year-old Iranian male patient, who was referred from another medical center with a decreased level of consciousness. Upon admission, only respiratory signs of COVID-19 were observed, but later, some neurological manifestations were also observed, such as an alteration in mental status, disorientation, stupor, and finally coma. In radiological studies, a hemorrhagic encephalopathy pattern was detected. Despite improved oxygenation and alleviation of respiratory symptoms with antiviral and anti-inflammatory therapies, cerebral injuries progressed, and the patient died due to severe brain damage.

Coronavirus and Its Implications for Psychiatry: A Rapid Review of the Early Literature

BACKGROUND

The coronavirus pandemic has changed health care rapidly and dramatically.

OBJECTIVE

To provide a critical synthesis of the scientific literature on the pandemic's implications for psychiatric practice.

METHODS

A rapid literature review was undertaken to identify scientific literature linking psychiatric outcomes and practice changes due to coronavirus and the disease it causes (COVID-19). A structured quality assessment was used to assess those articles reporting quantitative data.

RESULTS

Fifty articles were identified for inclusion, but only 12 contained original data. Eleven of those twelve were rated as of weak quality. The literature described psychiatric sequelae of the coronavirus and related public health interventions through cross-sectional surveys among different populations; no studies include diagnostic or functional impairment data. Populations at risk include COVID-19 survivors, health care workers, the elderly, and those with preexisting psychiatric disease. Impacts on psychiatric practice were described, again without data on changes to quality or access of care.

CONCLUSIONS

There is a quickly accumulating body of evidence on the psychiatric implications of coronavirus including psychological effects on the general public and at-risk subgroups. Similarly, psychiatric practice has witnessed substantial adaptation to the pandemic. However, there remain significant gaps in scientific knowledge. We suggest opportunities for consultation-liaison psychiatry to improve the understanding of the relationship between coronavirus and psychiatric care.

Proposal for a harmonized protocol for COVID-19 screening and necropsy in forensic sciences facilities

On 31 December 2019, health authorities in the People's Republic of China informed the World Health Organization of a then limited outbreak of interstitial viral pneumonia, identified at a laboratory in the city of Wuhan. In mid-April 2020 this outbreak of COVID-19 (as the disease has been called) has aggravated and spread worldwide, causing more than 200,000 deaths and affecting especially the United States, Spain, Italy, France and the United Kingdom. Despite the severity of the outbreak, the pathological findings have not been described in detail and there are very few guidelines or protocols for conducting autopsy studies on patients who have died from COVID-19. There are currently very few histopathological case series studies on this disease. In addition, some of these studies have been performed on biopsies or surgical resection pieces from patients in whom disease was subsequently demonstrated or through minimally invasive autopsy protocols. None of the studies offer a detailed necropsy protocol. This document proposes a protocol of action for the institutes of Forensic Medicine facing the current SARS-CoV2 pandemic, which combines protection of worker safety with optimization of tissue collection.

Trend of Olfactory and Gustatory Dysfunction in COVID-19 Patients in a Quarantine Facility

BACKGROUND

Olfactory and gustatory dysfunction has been reported as characteristic symptoms of coronavirus disease 2019 (COVID-19). This study evaluated olfactory and gustatory dysfunction in mild COVID-19 patients using validated assessment methods.

METHODS

A prospective surveillance study was conducted for mild COVID-19 patients who were isolated at the Gyeonggi International Living and Treatment Support Center (LTSC), Korea. Olfactory function was assessed using the Korean version of the Questionnaire of Olfactory Disorders (QOD) and Cross-Cultural Smell Identification Test (CC-SIT). Gustatory function was assessed using an 11-point Likert scale and 6-n-propylthiouracil, phenylthiocarbamide, and control strips. All patients underwent nasal and oral cavity endoscopic examination.

RESULTS

Of the 62 patients at the LTSC, 15 patients (24.2%) complained of olfactory or gustatory dysfunction on admission. Four of 10 patients who underwent functional evaluation did not have general symptoms and 2 were asymptomatic. The mean short version of QOD-negative statements and QOD-visual analogue scale scores were 13 ± 6 and 4.7 ± 3.6, respectively. The mean CC-SIT score was 8 ± 2. No patients showed anatomical abnormalities associated with olfactory dysfunction on endoscopic examination. The mean Likert scale score for function was 8 ± 2, and there were no abnormal lesions in the oral cavity of any patient.

CONCLUSIONS

The prevalence of olfactory and gustatory dysfunction was 24.2% in mild COVID-19 patients. All patients had hyposmia due to sensorineural olfactory dysfunction, which was confirmed using validated olfactory and gustatory evaluation methods and endoscopic examination. Olfactory and gustatory dysfunction may be characteristic indicators of mild COVID-19.

Cerebral ischemic and hemorrhagic complications of coronavirus disease 2019

BACKGROUND

The coronavirus disease 2019 is associated with neurological manifestations including stroke.

OBJECTIVES

We present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019.

METHODS

A retrospective study across two institutions was conducted between 20 March 2020 and 20 May 2020, for patients developing acute cerebrovascular disease and diagnosed with coronavirus disease 2019. We performed a literature review using the PubMed search engine.

RESULTS

The total sample size was 22 patients. The mean age was 59.5 years, and 12 patients were female. The cerebrovascular pathologies were 17 cases of acute ischemic stroke, 3 cases of aneurysm rupture, and 2 cases of sinus thrombosis. Of the stroke and sinus thrombosis patients, the mean National Institute of Health Stroke Scale was 13.8 ± 8.0, and 16 (84.2%) patients underwent a mechanical thrombectomy procedure. A favorable thrombolysis in cerebral infarction score was achieved in all patients. Of the 16 patients that underwent a mechanical thrombectomy, the mortality incidence was five (31.3%). Of all patients (22), three (13.6%) patients developed hemorrhagic conversion requiring decompressive surgery. Eleven (50%) patients had a poor functional status (modified Rankin Score 3-6) at discharge, and the total mortality incidence was eight (36.4%).

CONCLUSIONS

Despite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis. Notable features were younger age group, involvement of both the arterial and venous vasculature, multivessel involvement, and complicated procedures due to the clot consistency and burden.

Contemporary Analysis of Olfactory Dysfunction in Mild to Moderate Covid 19 Patients in A Tertiary Health Care Centre

Introduction: The World Health Organization declared COVID-19 a pandemic on March 11, 2020. The virus that causes COVID-19 was designated as severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). Several studies have reported chemosensory dysfunction, such as anosmia and ageusia, as common findings in COVID-19 positive patients. To date, qualitative olfactory testing has been performed only in a very few cohort studies on COVID-19 patients. However, objective testing is necessary to verify or determine the true magnitude of their deficits. Moreover, the proportion of COVID-19 patients exhibiting true olfactory disturbances is unknown. Aim of the Study: To determine the true prevalence of olfactory dysfunction in COVID-19 patients by objective assessment in mild to moderate symptomatic patients. Materials & Methodology: This was a prospective cross-sectional analytical study. All patients who were COVID-19 positive and having mild to moderate symptoms and not admitted in ICU formed part of the study group. Objective evaluation of smell function was done. Results: Self-reported smell dysfunction was present in 26.9% patients (n=62) and taste dysfunction was seen in 10.9% (n=25) of patients. On quantitative assessment of smell dysfunction, it was noted that 41.3% (n=95) of patients had some form of smell dysfunction out of which 70.5% patients (n=67) had hyposmia and 29.5% patients (n=28) had anosmia. Conclusion: Incidence was found to be more by objective assessment when compared to self-reported symptoms.

Symptomatology in head and neck district in coronavirus disease (COVID-19): A possible neuroinvasive action of SARS-CoV-2

OBJECTIVE

The aim of this manuscript is to investigate transversally Ear Nose Throat (ENT) symptoms COVID-19 infection correlated and to study the neurotropism and neuroinvasiveness of the virus in the head-neck district through the investigation of the sense of smell, taste, tearing, salivation and hearing.

METHODS

A total of 50 patients with laboratory-confirmed COVID-19 infection were included in our study. For each patient we evaluated the short version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS), the Summated Xerostomia Inventory-Dutch Version (SXI-DV), The Standardized Patient Evaluation of Eye Dryness (SPEED), Schirmer test I, the Hearing Handicap Inventory For Adults (HHIA) and the Tinnitus Handicap Inventory (THI). All the tests we carried out were performed during the active phase of the symptomatology from COVID-19 (Condition A) and 15 after SARS-COV-2 RT-PCR test negative (Condition B).

RESULTS

A total of 46 patients (92%) had olfactory dysfunction related to the infection. The 70% of patients reported gustatory disorders. Cough, fever, headache and asthenia were the most prevalent symptoms. There was a statistically significant difference (p < 0,001) in sQOD-NS, SXI-DV, SPEED, Schirmer test, HHIA and THI between Condition A and Condition B.

CONCLUSIONS

In our population there was an alteration of the sense of taste, of the sense of smell, dry eyes and of the oral cavity and an auditory discomfort, symptoms probably linked to the neurotropism of the virus. Furthermore, anosmia, dysgeusia and xerostomia are early symptoms of COVID-19, which can be exploited for an early quarantine and a limitation of viral contagion.

Do olfactory and gustatory psychophysical scores have prognostic value in COVID-19 patients? A prospective study of 106 patients

Background

The lack of objective data makes it difficult to establish the prognostic value of chemosensitive disorders in coronavirus disease 2019 (COVID-19) patients. We aimed to prospectively monitor patients diagnosed with COVID-19 to see if the severity of olfactory and gustatory dysfunction associates with subsequent disease severity.

Methods

Multicentre prospective study that recruited 106 COVID-19 subjects at diagnosis. Chemosensitive functions were assessed with psychophysical tests within 4 days of clinical onset, at 10 and 20 days. Daily body temperature and oxygen saturation were recorded as markers of disease severity alongside need for hospitalisation. The correlation between olfactory and gustatory scores and disease severity was assessed with linear regression analysis.

Results

At T0, 71 patients (67%) presented with olfactory dysfunction while gustatory impairment was detected in 76 cases (65.6%). Chemosensitive disorders gradually improved over the observation period. No significant correlations were found between T0 chemosensitive scores and final disease severity. The correlation between olfactory scores and fever proved significant at T2 (p = 0.05), while the relationship with gustatory scores was significant at T1 (p = 0.01) and T2 (p <  0.001), however neither was clinically relevant. The correlation between chemosensitive scores and oxygen saturation was significant only for taste at T2 (p <  0.001). Logistic regression analysis found significant correlations between olfactory impairment severity and need for hospitalization at T2 (OR 3.750, p = 0.005).

Conclusions

Initial objective olfactory and gustatory scores do not seem to have a significant prognostic value in predicting the severity of the COVID-19 course; however, persistence of olfactory dysfunction at 20 days, associated with a more severe course. Unfortunately, olfactory and gustatory dysfunction do not seem to hold prognostic value at the time of initial diagnosis.

High seroprevalence of SARS-CoV-2 in elderly care employees in Sweden

The COVID-19 pandemic is growing and spread in the Swedish elderly care system during April 2020. The increasing number of employees on sick-leave due to COVID-19 created severe logistic problems. Some elderly care homes therefore started to screen their personnel to secure the safety of the elderly and to avoid unnecessary quarantine of potentially immune employees. Secondary data from a screening with a COVID-19 rapid test for detection of SARS-CoV-2-specific IgM and IgG of 1,005 employees in 22 elderly care homes in Stockholm, Sweden, were analyzed. Seropositive employees were found in 21 out of the 22 care homes. In total, 23% (231/1,005) of the employees tested positive for antibodies against SARS-CoV-2, and 14.3% (144/1,005) were found positive for IgM (either alone or combined with IgG), indicating recent or present infection. Of those that tested seropositive, 46.5% did not report any clinical symptoms, indicating pre- or asymptomatic infections. Reported symptoms with the highest correlation with seropositivity were fever and loss of smell and taste. These results suggest that antibody testing of employees in elderly care homes is valuable for surveillance of disease development and a crucial screening tool in the effort to decrease the death toll in this pandemic.

Sudden onset, acute loss of taste and smell in coronavirus disease 2019 (COVID-19): a systematic review

BACKGROUND

Early detection, isolation and management of COVID-19 are crucial to contain the current pandemic. US Centers for Disease Control and Prevention (CDC) recently included 'sudden loss of taste (dysgeusia/ageusia) and smell (anosmia/hyposmia)' as symptoms of COVID-19. If indeed these symptoms are reliable and specific forerunner symptoms of COVID-19, then it may facilitate detection and containment of the disease. Hence, we systematically evaluated the contemporary evidence on dysgeusia and anosmia as trigger prodromal symptoms, and their prevalence in COVID-19 patients.

METHODS

Ovid MEDLINE, EBSCO host and Web of Science databases were searched between 25 December 2019 and 30 May 2020.

RESULTS

Of the 13 identified records, eight studies, totalling 11,054 COVID-19 patients, were included, as per the selection criteria. Eligible articles reflected research conducted mostly in the European community, as well as China, the US and Iran. In total, anosmia and dysgeusia symptoms were present in 74.9% and 81.3% ambulatory as well as hospitalized, mild-to-severe cases of COVID-19 patients, respectively. The European, US and Iran data indicate olfactory and gustatory symptoms appear prior to general COVID-19 symptoms in 64.5% and 54.0% of the patients, respectively.

CONCLUSIONS

To our knowledge, this is the first systematic review analysing the meager data based on the prevalence of chemosensory dysfunction in COVID-19. Critical analysis of such macro-data, as and when available, is essential to evaluate their utility as harbingers of COVID-19 onset, and to establish clinical practice guidelines both in dentistry and medicine.