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Grote H, Hoffmann A, Kerzel S, Lukasik H, Maier C, Mallon C, Schlegtendal A, Schwarzbach M, van Ackeren K, Volkenstein S, Brinkmann F. Subjective Smell Disturbances in Children with Sars-Cov-2 or Other Viral Infections do not Correspond with Olfactory Test Results. KLINISCHE PADIATRIE 2024; 236:129-138. [PMID: 38262421 DOI: 10.1055/a-2208-6245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Olfactory dysfunction associated with SARS-CoV-2 infection in children has not been verified by a validated olfactory test. We aimed to determine whether these complaints are objectifiable (test-based hyposmia), how often they occur during acute SARS-CoV-2 infection compared to other upper respiratory tract infections (URTI), as well as in children recovered from COVID-19 compared to children with long COVID. METHODS Olfactory testing (U-sniff test; hyposmia<8 points) and survey-based symptom assessments were performed in 434 children (5-17 years; 04/2021-06/2022). 186 symptom-free children served as controls. Of the children with symptoms of acute respiratory tract infection, SARS-CoV-2 PCR test results were positive in 45 and negative in 107 children (URTI group). Additionally, 96 children were recruited at least 4 weeks (17.6±15.2 weeks) after COVID-19, of whom 66 had recovered and 30 had developed long COVID. RESULTS Compared to controls (2.7%), hyposmia frequency was increased in all other groups (11-17%, p<0.05), but no between-group differences were observed. Only 3/41 children with hyposmia reported complaints, whereas 13/16 children with complaints were normosmic, with the largest proportion being in the long-COVID group (23%, p<0.05). CONCLUSION Questionnaires are unsuitable for assessing hyposmia frequency in children. Olfactory complaints and hyposmia are not specific for SARS-CoV-2 infection. The number of complaints in the long-COVID group could result from aversive olfactory perception, which is undetectable with the U-sniff test.
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Affiliation(s)
- Hanna Grote
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
- Department of Pediatric Pneumology and Allergology, University Children's Hospital Regensburg at Campus St. Hedwig, University Regensburg, University Hospital Regensburg, Germany
| | - Anna Hoffmann
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergology, University Children's Hospital Regensburg at Campus St. Hedwig, University Regensburg, University Hospital Regensburg, Germany
| | - Hannah Lukasik
- Department of Ear, Nose and Throat, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Christoph Maier
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Claire Mallon
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Anne Schlegtendal
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Michaela Schwarzbach
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Konstantin van Ackeren
- Department of Ear, Nose and Throat, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Stefan Volkenstein
- Department of Ear, Nose and Throat, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Folke Brinkmann
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
- Department of Paediatric Pneumology, University Hospital Schleswig Holstein Campus Lübeck, Lübeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research, Lübeck, Germany
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2
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Wang JY, Pao JB, Lee CH, Wang JY, Lee MC, Wu TT. Corticosteroids for COVID-19-induced olfactory dysfunction: A comprehensive systematic review and meta-analysis of randomized controlled trials. PLoS One 2023; 18:e0289172. [PMID: 38127940 PMCID: PMC10734960 DOI: 10.1371/journal.pone.0289172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Olfactory dysfunction is a common manifestation in COVID-19 patients and can significantly impact their quality of life. Corticosteroids have been proposed as a potential treatment, but their efficacy remains controversial. This systematic review and meta-analysis aims to comprehensively analyze the efficacy of corticosteroid therapy for treating COVID-19-related olfactory dysfunction. METHODS A literature search was conducted in PubMed, Cochrane Library, and Embase databases up to March 1, 2023. Randomized controlled trials investigating the effects of corticosteroids on olfactory dysfunction in patients with COVID-19 were included. The primary outcome was the olfactory score at the end of follow-up, and the secondary outcomes were the duration and the rate of recovery from olfactory dysfunction. RESULTS Seven randomized controlled trials with 999 participants were included in the meta-analysis. Compared with the control group, corticosteroid treatment resulted in a statistically significant improvement in olfactory score with a standardized mean difference of 0.55 (95% CI: 0.15 to 0.95). Topical corticosteroids were found to be effective, but systemic corticosteroids were not. In addition, longer durations and higher dosages of corticosteroids treatment may also be associated with significant improvements in olfactory scores. No significant effect was observed on the duration or recovery rate of olfactory dysfunction. CONCLUSIONS Our findings suggest that topical corticosteroid treatment is a viable option for improving COVID-19-related olfactory dysfunction, but further research is needed to investigate optimal treatment protocols and safety profiles.
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Affiliation(s)
- Jian-Ying Wang
- Department of Pharmacy, New Taipei City Hospital, New Taipei City, Taiwan
| | - Jiunn-Bey Pao
- Section of Clinical Pharmacy, Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Chih-Hsin Lee
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chia Lee
- Department of Pharmacy, New Taipei City Hospital, New Taipei City, Taiwan
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Cardinal Tien College of Healthcare and Management, Taipei, Taiwan
| | - Tzu-Tuan Wu
- Department of Internal Medicine, New Taipei City Hospital, New Taipei City, Taiwan
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3
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Evman MD, Cetin ZE. Effectiveness of platelet-rich plasma on post-COVID chronic olfactory dysfunction. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230666. [PMID: 37909619 PMCID: PMC10610757 DOI: 10.1590/1806-9282.20230666] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/30/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the efficacy of platelet-rich plasma injection on the olfactory cleft of patients with post-COVID olfactory dysfunction lasting over 1 year, who were unresponsive to common treatments. METHODS Patients over 18 years of age with post-COVID olfactory dysfunction over 1 year whose complaints did not improve with intranasal steroids and D-panthenol/vitamin A combination nasal sprays with olfactory rehabilitation training for 1 month were prospectively collected and randomized into two groups: intranasal platelet-rich plasma group and control group. At the end of 1 month, Connecticut Chemosensory Clinical Research Center olfaction test scores of smell detection threshold and smell identification test were compared accordingly. RESULTS A total of 25 patients were randomized into platelet-rich plasma (n=12) and control (n=13) groups. In the platelet-rich plasma group, the mean smell detection threshold score increased from 5.63 (SD 0.68) to 6.46 (SD 0.45), and the mean smell identification test score increased from 11.42 (SD 1.17) to 15.17 (SD 0.39). In the control group, the mean smell detection threshold score changed from 5.69 (SD 0.66) to 5.77 (SD 0.70), and the mean smell identification test score changed from 11.20 (SD 1.12) to 11.85 (SD 1.57). Post-hoc analysis revealed that similar mean smell detection threshold (mean difference 0.07; p=0.994) and smell identification test (mean difference -0.50; p=0.703) scores were transformed into a significant difference between groups (smell detection threshold mean difference 0.69; p=0.037; smell identification test mean difference 3.32; p<0.001). CONCLUSION At the end of the first month, there was a significant improvement in olfactory threshold values in the platelet-rich plasma group compared to the control group. No side effect or adverse event related to platelet-rich plasma injection was observed.
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Affiliation(s)
- Melis Demirag Evman
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Otolaryngology Head and Neck Surgery – Istanbul, Turkey
| | - Zeynep Erdogan Cetin
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Otolaryngology Head and Neck Surgery – Istanbul, Turkey
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4
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Schepens EJA, Kamalski DMA, Stegeman I. A Comparative Analysis of the Incidence, Severity and Duration of Smell and Taste Loss in COVID-19 Cases Versus Non-COVID-19 Cases: A Longitudinal Cohort Study. J Clin Med 2023; 12:6267. [PMID: 37834912 PMCID: PMC10573822 DOI: 10.3390/jcm12196267] [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: 08/22/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
The COVID-19 pandemic has highlighted the relevance of olfactory and gustatory disorders. However, these symptoms can also be caused by various other factors. In this study we aimed to compare the incidence, severity and duration between COVID-19 related and non-COVID-19 related smell and taste disorders. We conducted a longitudinal cohort study using data from the Dutch biobank Lifelines, which includes over 167,000 participants. The data were collected using 27 questionnaires distributed between March 2020 and May 2022. Descriptive data and the incidence of smell and taste loss in both groups were calculated. To visualize the proportion of severity rates of symptoms, a heatmap was created. A survival analysis was conducted and presented in a reversed Kaplan-Meier curve to show the probability of having persistent smell loss in both groups. The study included 235,722 participants. The incidence of smell loss was higher in the COVID-19 positive group, when compared to the COVID-19 negative group. We found varying degrees of symptom severity in COVID-19 positive cases, ranging from mild to severe, while non-COVID-19 related cases mostly reported mild symptoms. The survival outcome for smell and taste loss was 0.12 (SE 0.03, 95% CI 0.07-0.21) in COVID-19 related cases, and was 0.17 (SE 0.03, 95% CI 0.12-0.24) in cases related to other causes. This study reveals a higher incidence and severity of smell and taste loss in individuals with COVID-19 compared to non-COVID-19 related cases. However, non-COVID-19 related smell and taste loss tend to have a longer duration.
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Affiliation(s)
- Emma J. A. Schepens
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.M.A.K.); (I.S.)
- Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Digna M. A. Kamalski
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.M.A.K.); (I.S.)
- Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.M.A.K.); (I.S.)
- Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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5
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Andrea XP, Joceline LM, Jose OF, Jose PO. Human Nasal Epithelium Damage as the Probable Mechanism Involved in the Development of Post-COVID-19 Parosmia. Indian J Otolaryngol Head Neck Surg 2023; 75:458-464. [PMID: 36817017 PMCID: PMC9927037 DOI: 10.1007/s12070-023-03559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Purpose Since the beginning of the COVID-19 pandemic, understanding the physiopathological mechanisms of its manifestations has been crucial to understand the disease and its implications. As the disease evolved, post-infection complications have arisen such as olfactory dysfunctions including parosmia in which odourants are perceived in a distorted or an unpleasant way. Methods In this article, we attempt to clarify these mechanisms and the role of human nasal epithelium in the development of post-COVID-19 parosmia. Results The mechanisms by which SARS-CoV-2 generates olfactory dysfunction have not been elucidated, and multiple theories have been proposed pointing to the sustentacular cells of the olfactory epithelium as the main probable target of the virus. Conclusion Establishing the main physiopathological mechanism of post-COVID-19 parosmia will set a path for further investigations and determine treatment and preventive options for patients who have been reported to be extensively affected in multiple aspects of their lives such as eating habits and mental health.
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Affiliation(s)
- Xolalpa-Peniche Andrea
- grid.441070.60000 0001 2111 4953Facultad Mexicana de Medicina, Universidad La Salle, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, México
| | - Lucas-Mata Joceline
- grid.441070.60000 0001 2111 4953Facultad Mexicana de Medicina, Universidad La Salle, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, México
| | - Osante-Forastieri Jose
- grid.441070.60000 0001 2111 4953Facultad Mexicana de Medicina, Universidad La Salle, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, México
| | - Pérez-Ochoa Jose
- grid.441070.60000 0001 2111 4953Facultad Mexicana de Medicina, Universidad La Salle, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, México
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6
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Shirai T, Takase D, Yokoyama J, Nakanishi K, Uehara C, Saito N, Kato-Namba A, Yoshikawa K. Functions of human olfactory mucus and age-dependent changes. Sci Rep 2023; 13:971. [PMID: 36653421 PMCID: PMC9846672 DOI: 10.1038/s41598-023-27937-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
Odorants are detected by olfactory sensory neurons, which are covered by olfactory mucus. Despite the existence of studies on olfactory mucus, its constituents, functions, and interindividual variability remain poorly understood. Here, we describe a human study that combined the collection of olfactory mucus and olfactory psychophysical tests. Our analyses revealed that olfactory mucus contains high concentrations of solutes, such as total proteins, inorganic elements, and molecules for xenobiotic metabolism. The high concentrations result in a capacity to capture or metabolize a specific repertoire of odorants. We provide evidence that odorant metabolism modifies our sense of smell. Finally, the amount of olfactory mucus decreases in an age-dependent manner. A follow-up experiment recapitulated the importance of the amount of mucus in the sensitive detection of odorants by their receptors. These findings provide a comprehensive picture of the molecular processes in olfactory mucus and propose a potential cause of olfactory decline.
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Affiliation(s)
- Tomohiro Shirai
- Sensory Science Research, Kao Corporation, 2606 Akabane, Ichikai-machi, Haga, Tochigi, Japan
| | - Dan Takase
- Sensory Science Research, Kao Corporation, 2606 Akabane, Ichikai-machi, Haga, Tochigi, Japan
| | - Junkichi Yokoyama
- Department of Otolaryngology-Head and Neck Surgery, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawa, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Nadogaya Hospital, 2-1-1 Shinkashiwa, Kashiwa, Chiba, Japan
| | - Kuniyuki Nakanishi
- Analytical Science Research, Kao Corporation, 1334 Minato, Wakayama, Wakayama, Japan
| | - Chisaki Uehara
- Sensory Science Research, Kao Corporation, 2606 Akabane, Ichikai-machi, Haga, Tochigi, Japan
| | - Naoko Saito
- Sensory Science Research, Kao Corporation, 2606 Akabane, Ichikai-machi, Haga, Tochigi, Japan
| | - Aya Kato-Namba
- Sensory Science Research, Kao Corporation, 2606 Akabane, Ichikai-machi, Haga, Tochigi, Japan
| | - Keiichi Yoshikawa
- Sensory Science Research, Kao Corporation, 2606 Akabane, Ichikai-machi, Haga, Tochigi, Japan.
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Chee J, Chern B, Loh WS, Mullol J, Wang DY. Pathophysiology of SARS-CoV-2 Infection of Nasal Respiratory and Olfactory Epithelia and Its Clinical Impact. Curr Allergy Asthma Rep 2023; 23:121-131. [PMID: 36598732 PMCID: PMC9811886 DOI: 10.1007/s11882-022-01059-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW While the predominant cause for morbidity and mortality with SARS-CoV-2 infection is the lower respiratory tract manifestations of the disease, the effects of SARS-CoV-2 infection on the sinonasal tract have also come to the forefront especially with the increased recognition of olfactory symptom. This review presents a comprehensive summary of the mechanisms of action of the SARS-CoV-2 virus, sinonasal pathophysiology of COVID-19, and the correlation with the clinical and epidemiological impact on olfactory dysfunction. RECENT FINDINGS ACE2 and TMPRSS2 receptors are key players in the mechanism of infection of SARS-CoV-2. They are present within both the nasal respiratory as well as olfactory epithelia. There are however differences in susceptibility between different groups of individuals, as well as between the different SARS-CoV-2 variants. The sinonasal cavity is an important route for SARS-CoV-2 infection. While the mechanism of infection of SARS-CoV-2 in nasal respiratory and olfactory epithelia is similar, there exist small but significant differences in the susceptibility of these epithelia and consequently clinical manifestations of the disease. Understanding the differences and nuances in sinonasal pathophysiology in COVID-19 would allow the clinician to predict and counsel patients suffering from COVID-19. Future research into molecular pathways and cytokine responses at different stages of infection and different variants of SARS-CoV-2 would evaluate the individual clinical phenotype, prognosis, and possibly response to vaccines and therapeutics.
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Affiliation(s)
- Jeremy Chee
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Beverlyn Chern
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Woei Shyang Loh
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore ,grid.4280.e0000 0001 2180 6431Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joaquim Mullol
- grid.10403.360000000091771775Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Catalonia Spain
| | - De Yun Wang
- Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Yang Z, Ma Y, Bi W, Tang J. Exploring the research landscape of COVID-19-induced olfactory dysfunction: A bibliometric study. Front Neurosci 2023; 17:1164901. [PMID: 37034158 PMCID: PMC10079987 DOI: 10.3389/fnins.2023.1164901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Since the outbreak of COVID-19, olfactory dysfunction (OD) has become an important and persistent legacy problem that seriously affects the quality of life. The purpose of this paper is to quantitatively analyze and visualize the current research status and development trend of COVID-19 related OD by using VOSviewer software. Based on the Web of Science database, a total of 1,592 relevant documents were retrieved in January 2023, with publication time spanning from 2020 to 2023. The bibliometric analysis revealed that the most influential research results in the field of COVID-19 related OD were concentrated in journals of related disciplines such as otorhinolaryngology, medicine, general and internal, virology, neurosciences, etc. The knowledge base of the research is mainly formed in two fields: COVID-19 clinical research and OD specialized research. The research hotspots are mainly concentrated in six directions: COVID-19, long COVID, smell, anosmia, OD, and recovery. Based on the results of the bibliometric analysis, the temporal trends of COVID-19 related OD studies were visually revealed, and relevant suggestions for future research were proposed.
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Affiliation(s)
- Zhirong Yang
- Library of Zhuhai Campus, Jinan University, Zhuhai, China
| | - Yukun Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wei Bi
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Wei Bi
| | - Jingqian Tang
- Department of Subject Service and Consultation, Jinan University Library, Guangzhou, China
- Intellectual Property Information Service Center, Jinan University, Guangzhou, China
- Jingqian Tang
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Mendes Paranhos AC, Nazareth Dias ÁR, Machado da Silva LC, Vieira Hennemann Koury G, de Jesus Sousa E, Cerasi AJ, Souza GS, Simões Quaresma JA, Magno Falcão LF. Sociodemographic Characteristics and Comorbidities of Patients With Long COVID and Persistent Olfactory Dysfunction. JAMA Netw Open 2022; 5:e2230637. [PMID: 36074464 PMCID: PMC9459661 DOI: 10.1001/jamanetworkopen.2022.30637] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Determining the characteristics, type, and severity of olfactory dysfunction in patients with long COVID is important for the prognosis and potential treatment of the affected population. OBJECTIVE To describe the sociodemographic and clinical features of patients with long COVID who develop persistent olfactory dysfunction. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study, conducted at a rehabilitation center at a public university in the Amazon region of Brazil between September 9, 2020, and October 20, 2021, comprised 219 patients with long COVID and self-reported neurologic symptoms. Of these 219 patients, 139 received a diagnosis of chronic olfactory dysfunction, as confirmed by the Connecticut Chemosensory Clinical Research Center (CCCRC) test. EXPOSURE Clinical diagnosis of long COVID. MAIN OUTCOMES AND MEASURES Electronic case report forms were prepared for the collection of sociodemographic and clinical data. Patients' sense of smell was evaluated via a CCCRC test, and the association of olfactory dysfunction with aspects of daily life was recorded using a questionnaire. RESULTS Of the 219 patients included in the study, 164 (74.9%) were women, 194 (88.6%) were between 18 and 59 years of age (mean [SD] age, 43.2 [12.9] years), 206 (94.1%) had more than 9 years of education, and 115 (52.5%) had a monthly income of up to US $192.00. In the study group, 139 patients (63.5%) had some degree of olfactory dysfunction, whereas 80 patients (36.5%) had normosmia. Patients with olfactory dysfunction had a significantly longer duration of long COVID symptoms than those in the normosmia group (mean [SD], 242.7 [101.9] vs 221.0 [97.5] days; P = .01). Among patients with anosmia, there was a significant association between olfactory dysfunction and daily activities, especially in terms of impairment in hazard detection (21 of 31 patients [67.7%]), personal hygiene (21 of 31 patients [67.7%]), and food intake (21 of 31 patients [67.7%]). Univariable logistic regression analyses found that ageusia symptoms were associated with the occurrence of olfactory dysfunction (odds ratio [OR], 11.14 [95% CI, 4.76-26.07]; P < .001), whereas headache (OR, 0.41 [95% CI, 0.22-0.76]; P < .001) and sleep disorders (OR, 0.48 [95% CI, 0.26-0.92]; P = .02) showed an inverse association with the occurrence of olfactory dysfunction. CONCLUSIONS AND RELEVANCE Olfactory dysfunction is one of the most important long-term neurologic symptoms of COVID-19, with the highest prevalence seen among women, adults, and outpatients. Patients with olfactory dysfunction may experience persistent severe hyposmia or anosmia more than 1 year from the onset of symptoms, suggesting the possibility of the condition becoming a permanent sequela.
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Affiliation(s)
- Alna Carolina Mendes Paranhos
- Tropical Medicine Center, Federal University of Pará, Belém, Brazil
- Biological and Health Center, Pará State University, Belém, Brazil
| | | | | | | | | | - Antônio José Cerasi
- Biological Science Center, Federal University of Pará, Belém, Brazil
- Cosmopolita College, Belém, Brazil
| | - Givago Silva Souza
- Tropical Medicine Center, Federal University of Pará, Belém, Brazil
- Biological Science Center, Federal University of Pará, Belém, Brazil
| | - Juarez Antônio Simões Quaresma
- Tropical Medicine Center, Federal University of Pará, Belém, Brazil
- Biological and Health Center, Pará State University, Belém, Brazil
| | - Luiz Fábio Magno Falcão
- Biological and Health Center, Pará State University, Belém, Brazil
- University of São Paulo, São Paulo, Brazil
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10
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Avnat E, Shapira G, Gurwitz D, Shomron N. Elevated Expression of RGS2 May Underlie Reduced Olfaction in COVID-19 Patients. J Pers Med 2022; 12:jpm12091396. [PMID: 36143181 PMCID: PMC9504192 DOI: 10.3390/jpm12091396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Anosmia is common in COVID-19 patients, lasting for weeks or months following recovery. The biological mechanism underlying olfactory deficiency in COVID-19 does not involve direct damage to nasal olfactory neurons, which do not express the proteins required for SARS-CoV-2 infection. A recent study suggested that anosmia results from downregulation of olfactory receptors. We hypothesized that anosmia in COVID-19 may also reflect SARS-CoV-2 infection-driven elevated expression of regulator of G protein signaling 2 (RGS2), a key regulator of odorant receptors, thereby silencing their signaling. To test our hypothesis, we analyzed gene expression of nasopharyngeal swabs from SARS-CoV-2 positive patients and non-infected controls (two published RNA-sequencing datasets, 580 individuals). Our analysis found upregulated RGS2 expression in SARS-CoV-2 positive patients (FC = 14.5, Padj = 1.69 × 10−5 and FC = 2.4; Padj = 0.001, per dataset). Additionally, RGS2 expression was strongly correlated with PTGS2, IL1B, CXCL8, NAMPT and other inflammation markers with substantial upregulation in early infection. These observations suggest that upregulated expression of RGS2 may underlie anosmia in COVID-19 patients. As a regulator of numerous G-protein coupled receptors, RGS2 may drive further neurological symptoms of COVID-19. Studies are required for clarifying the cellular mechanisms by which SARS-CoV-2 infection drives the upregulation of RGS2 and other genes implicated in inflammation. Insights on these pathway(s) may assist in understanding anosmia and additional neurological symptoms reported in COVID-19 patients.
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Affiliation(s)
- Eden Avnat
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Guy Shapira
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv 69978, Israel
| | - David Gurwitz
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (D.G.); (N.S.); Tel.: +972-3-640-7611 (D.G.); +972-3-640-6594 (N.S.)
| | - Noam Shomron
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv 69978, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (D.G.); (N.S.); Tel.: +972-3-640-7611 (D.G.); +972-3-640-6594 (N.S.)
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11
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Park JW, Wang X, Xu RH. Revealing the mystery of persistent smell loss in Long COVID patients. Int J Biol Sci 2022; 18:4795-4808. [PMID: 35874953 PMCID: PMC9305264 DOI: 10.7150/ijbs.73485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022] Open
Abstract
COVID-19 is hopefully approaching its end in many countries as herd immunity develops and weaker strains of SARS-CoV-2 dominate. However, a new concern occurs over the long-term effects of COVID-19, collectively called "Long COVID", as some symptoms of the nervous system last even after patients recover from COVID-19. This review focuses on studies of anosmia, i.e., impairment of smell, which is the most common sensory defect during the disease course and is caused by olfactory dysfunctions. It remains mysterious how the olfactory functions are affected since the virus can't invade olfactory receptor neurons. We describe several leading hypotheses about the mystery in hope to provide insights into the pathophysiology and treatment strategies for anosmia.
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Affiliation(s)
- Jung Woo Park
- Center of Reproduction, Development & Aging, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau, China.,Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Taipa, Macau, China
| | - Xiaoyan Wang
- Center of Reproduction, Development & Aging, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau, China.,Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Taipa, Macau, China
| | - Ren-He Xu
- Center of Reproduction, Development & Aging, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau, China.,Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Taipa, Macau, China
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12
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Basir HRG, Majzoobi MM, Ebrahimi S, Noroozbeygi M, Hashemi SH, Keramat F, Mamani M, Eini P, Alizadeh S, Solgi G, Di D. Susceptibility and Severity of COVID-19 Are Both Associated With Lower Overall Viral–Peptide Binding Repertoire of HLA Class I Molecules, Especially in Younger People. Front Immunol 2022; 13:891816. [PMID: 35911710 PMCID: PMC9331187 DOI: 10.3389/fimmu.2022.891816] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/10/2022] [Indexed: 12/24/2022] Open
Abstract
An important number of studies have been conducted on the potential association between human leukocyte antigen (HLA) genes and COVID-19 susceptibility and severity since the beginning of the pandemic. However, case–control and peptide-binding prediction methods tended to provide inconsistent conclusions on risk and protective HLA alleles, whereas some researchers suggested the importance of considering the overall capacity of an individual’s HLA Class I molecules to present SARS-CoV-2-derived peptides. To close the gap between these approaches, we explored the distributions of HLA-A, -B, -C, and -DRB1 1st-field alleles in 142 Iranian patients with COVID-19 and 143 ethnically matched healthy controls, and applied in silico predictions of bound viral peptides for each individual’s HLA molecules. Frequency comparison revealed the possible predisposing roles of HLA-A*03, B*35, and DRB1*16 alleles and the protective effect of HLA-A*32, B*58, B*55, and DRB1*14 alleles in the viral infection. None of these results remained significant after multiple testing corrections, except HLA-A*03, and no allele was associated with severity, either. Compared to peptide repertoires of individual HLA molecules that are more likely population-specific, the overall coverage of virus-derived peptides by one’s HLA Class I molecules seemed to be a more prominent factor associated with both COVID-19 susceptibility and severity, which was independent of affinity index and threshold chosen, especially for people under 60 years old. Our results highlight the effect of the binding capacity of different HLA Class I molecules as a whole, and the more essential role of HLA-A compared to HLA-B and -C genes in immune responses against SARS-CoV-2 infection.
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Affiliation(s)
- Hamid Reza Ghasemi Basir
- Department of Pathology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Samaneh Ebrahimi
- Department of Immunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mina Noroozbeygi
- Department of Immunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Hamid Hashemi
- Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fariba Keramat
- Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mojgan Mamani
- Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Peyman Eini
- Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeed Alizadeh
- Department of Radiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghasem Solgi
- Department of Immunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- *Correspondence: Ghasem Solgi, ; Da Di,
| | - Da Di
- Anthropology Unit, Department of Genetics and Evolution, University of Geneva, Geneva, Switzerland
- *Correspondence: Ghasem Solgi, ; Da Di,
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13
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Gupta S, Lee JJ, Perrin A, Khan A, Smith HJ, Farrell N, Kallogjeri D, Piccirillo JF. Efficacy and Safety of Saline Nasal Irrigation Plus Theophylline for Treatment of COVID-19-Related Olfactory Dysfunction: The SCENT2 Phase 2 Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2022; 148:830-837. [PMID: 35797024 DOI: 10.1001/jamaoto.2022.1573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Recent studies suggest that theophylline added to saline nasal irrigation (SNI) can be an effective treatment for postviral olfactory dysfunction (OD), a growing public health concern during the COVID-19 pandemic. Objective To evaluate the efficacy and safety of theophylline added to SNI compared with placebo for COVID-19-related OD. Design, Setting, and Participants This triple-blinded, placebo-controlled, phase 2 randomized clinical trial was conducted virtually between March 15 and August 31, 2021. Adults residing in Missouri or Illinois were recruited during this time period if they had OD persisting for 3 to 12 months following suspected COVID-19 infection. Data analysis was conducted from October to December 2021. Interventions Saline sinus rinse kits and bottles of identical-appearing capsules with either 400 mg of theophylline (treatment) or 500 mg of lactose powder (control) were mailed to consenting study participants. Participants were instructed to dissolve the capsule contents into the saline rinse and use the solution to irrigate their nasal cavities in the morning and at night for 6 weeks. Main Outcomes and Measures The primary outcome was the difference in the rate of responders between the treatment and the control arms, defined as a response of at least slightly better improvement in the Clinical Global Impression-Improvement scale posttreatment. Secondary outcome measures included changes in the University of Pennsylvania Smell Identification Test (UPSIT), the Questionnaire for Olfactory Disorders, the 36-Item Short Form Health Survey on general health, and COVID-19-related questions. Results A total of 51 participants were enrolled in the study; the mean (SD) age was 46.0 (13.1) years, and 36 (71%) participants were women. Participants were randomized to SNI with theophylline (n = 26) or to SNI with placebo (n = 25). Forty-five participants completed the study. At the end of treatment, 13 (59%) participants in the theophylline arm reported at least slight improvement in the Clinical Global Impression-Improvement scale (responders) compared with 10 (43%) in the placebo arm (absolute difference, 15.6%; 95% CI, -13.2% to 44.5%). The median difference for the UPSIT change between baseline and 6 weeks was 3.0 (95% CI, -1.0 to 7.0) for participants in the theophylline arm and 0.0 (95% CI, -2.0 to 6.0) for participants in the placebo arm. Mixed-model analysis revealed that the change in UPSIT scores through study assessments was not statistically significantly different between the 2 study arms. Eleven (50%) participants in the theophylline arm and 6 (26%) in the placebo arm had a change of 4 or more points in UPSIT scores from baseline to 6 weeks. The difference in the rate of responders as measured by the UPSIT was 24% (95% CI, -4% to 52%) in favor of theophylline. Conclusions and Relevance This randomized clinical trial suggests that the clinical benefit of theophylline nasal irrigations on olfaction in participants with COVID-19-related OD is inconclusive, though suggested by subjective assessments. Larger studies are warranted to investigate the efficacy of this treatment more fully. Trial Registration ClinicalTrials.gov Identifier: NCT04789499.
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Affiliation(s)
- Shruti Gupta
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.,Medical College of Georgia, Augusta University, Augusta
| | - Jake J Lee
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Amber Perrin
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Amish Khan
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | - Nyssa Farrell
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jay F Piccirillo
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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14
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Alrasheedi A. Characterization, treatment modalities, and self-perceived improvement of post-COVID-19 phantosmia: a case series of eleven patients. RHINOLOGY ONLINE 2022. [DOI: 10.4193/rhinol/22.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Loss of smell and taste is one of the early and sensitive symptoms of COVID-19 that usually improves over time. Post-COVID-19 phantosmia, a smell distorted sensation without the presence of odorants, has deleterious and long-lasting effects on the patient's quality of life. We aimed to present our experience with phantosmia. Case presentations: We report a description of a series of eleven cases (age of 29 ± 9 years, and 54.5% females) of post-COVID-19 phantosmia without any other comorbidity, and the effects of combined treatment modalities (olfactory training, nasal irrigation with budesonide and oral prednisolone) on self-perceived improvement in phantosmia. Conclusions: We postulate that the combined 10 days oral prednisolone, smell training, and nasal irrigation for three months improved post-COVID-19 phantosmia assessed as post vs. pre self-perceived improvement, although this was not aimed at as a treatment since it was not compared to untreated controls.
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15
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Niazi AUR, Alekozay M, Najm AF. RESEARCH ARTICLEPrevalence and associated factors of depression, anxiety and stress among coronavirus disease 2019 (COVID-19) patients in Heart, Afghanistan. GLOBAL HEALTH JOURNAL 2022; 6:85-90. [PMID: 35223130 PMCID: PMC8863950 DOI: 10.1016/j.glohj.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives Coronavirus disease 2019 (COVID-19) pandemic has been associated with a great level of psychological distresses in people around the world. This study aims to assess the prevalence of depression, anxiety and stress among COVID-19 patients and identify the associated factors, in Herat Province of Afghanistan. Methods This cross-sectional study was conducted on 459 hospitalized patients between May and September 2021. Data was collected with a structured questionnaire on depression, anxiety and stress scale, which was the validated Dari-version. Chi-square test was adopted to analyze the associations of the prevalence of the mental disorders and the factors. Results The mean age of participants was 38.05; 51.9% (238/459) were male and 84.1% (386/459) were married. Median scores for depression, anxiety and stress were 5.0, 8.0, and 10.0, respectively. Gender, general health condition, nutritional status, COVID-19 clinical manifestation and concurrent comorbidities (except diabetes and hypertension) were significantly associated with mental disorders; while association between marital status and these psychological disorders was not significant. Moreover, a significant difference was observed in the level of anxiety between healthcare workers and other respondents. Conclusion This is the first study to report the high prevalence of depression, anxiety and stress among COVID-19 patients in Herat, which indicates the negative effect of mental health for COVID-19 patients globally and highlights the need for urgent and appropriate interventions to improve mental health of people during the pandemic.
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Affiliation(s)
- Aziz-Ur-Rahman Niazi
- Department of Public Health and Infectious Diseases, Faculty of Medicine, Herat University, Herat, Afghanistan
| | - Mina Alekozay
- Department of Public Health and Infectious Diseases, Faculty of Medicine, Herat University, Herat, Afghanistan
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