Recovery Patterns of COVID-19 Related Smell Disorders: An Analysis of the Available Evidence

Recently acquired olfactory dysfunction (OD) has emerged as one of hallmark manifestations of the novel Corona virus disease (COVID-19), but the evolution of its spontaneous recovery has remained inconclusive, with reports of persistence of OD beyond six months of onset. We undertook this systematic review and meta-analysis with a view to generating a pooled recovery rate of COVID-19 associated olfactory dysfunctions and attempt to examine the predictors of olfactory recovery. Systematic review and meta-analysis. A systematic search of Scopus, Google Scholar, and PubMed data bases, comprising all longitudinal studies reporting the trajectory of COVID-19 related OD was carried out. The pooled recovery rate was estimated with random-effects model, and the potential heterogeneity of the subgroup sources was analyzed using meta-regression test. After the PRISMA selection process 28 studies from 16 countries were included, with a total of 5,175 OD patients, among 11,948 COVID-19 cases. The estimated global pooled recovery rate of OD was 82.7% (95% CI, 77.46%-88.04%), with a pooled median duration of OD of 11.6 days. Only 2 out of 28 studies had recovery data beyond a period of 2 months. But no significant difference was found in the recovery rate regarding the length of follow up (P = 0.840). Studies that conducted objective olfactory assessments showed significant higher recovery rate than those with subjective assessments (P = 0.001). Although ten studies (36%) reported > 90% recovery, nine studies (32%) documented persistence of OD in > 25% of their patients. Five out of 6 studies showed that hyposmia tended to show complete recovery than anosmia. Age, co-morbidities, and intra-nasal treatments had no effects. Test of homogeneity between subgroups using the Cochran's Q test was not significant (Q = 0.69, P = 0.40). Our meta-analysis revealed high rate of early and medium term recovery of COVID-19 related OD. However, it also showed disturbing rates of persistence of OD. Anosmia tended to be predictive of residual OD than hyposmia. Age, co-morbidities, intra-nasal corticosteroid and decongestants, had no effects on OD recovery.

Neutralizing anti-polio antibody titre in newborn babies in post-polio eradication period in Nigeria

BACKGROUND

According to Polio Eradication and Endgame Strategic Plan 2019-2023 (PEESP), countries that achieved wild polio elimination is expected to replace oral polio vaccine (OPV) which has a risk of vaccine-derived poliovirus, Inactivated Polio Vaccine (IPV). It is important to determine the earliest time in the age of a child at which IPV could be introduced into the country's routine immunization schedule for effectiveness especially as it concerns neutralizing effect of trans-placental transmitted antibodies which usually does not affect OPV. In this study, the level of poliovirus neutralizing antibody titre among neonates at birth was evaluated.

METHODS

A cross-sectional study of mother-baby pair. The serum level of the neutralizing Poliovirus antibody IgG titre was done by the Enzyme Linked Immunosorbent Assay (ELISA) technique.

RESULTS

There was 100% transfer of maternal passive antibodies to their babies. The mean poliovirus antibody titre among neonates was 21.8 IU/L which was above the neutralizing titre level. Most (85.7%) babies antibody level correlate positively with that of their mothers.

CONCLUSION

The transferred maternal antibodies to the babies are still very high at birth, and capable of dampening the immunity of IPV if introduced early. Programme managers should evaluate the impact and benefit of given booster dose of IPV to pregnant mothers to increase the titre level in their babies. This will be very necessary when the OPV is withdrawn from the immunization schedule.

Traumatic Tongue Laceration: An Experience of Two Tertiary Centers in South East Nigeria

Background

Traumatic injuries to the orofacial region are common and can be challenging to the oral and maxillofacial surgeon. The tongue is one of the structures that can be involved; however, the incidence of this injury to the tongue appears rare. Most of the reported work on this topic is on children.

Patients and Methods

This is a three-year prospective study of traumatic tongue lacerations managed at the oral and maxillofacial centers of two tertiary hospitals in the southeast of Nigeria.

Result

A total of 37 cases with tongue lacerations among 353 patients with oral and maxillofacial trauma constituting a prevalence of 10.5%. Their age ranged from 6 months to 57 years with a mean of 18.4 years (standard deviation 17.5). Twenty three (62.2%) are males and 14 (37.8%) females in a ratio of 1.6:1. The duration of injury on presentation ranged from 45 minutes to 96 hours with a mean duration of 26.7 hours. Majority of the laceration occurred in the anterior part of the tongue (24) (64.9%). Thirteen falls (35.1%) and nine motor vehicle accidents (24.3%) were the most common etiology. Thirty six (97.3%) were sutured primarily on presentation while only one (2.7%) was delayed before closure. Anesthesia was achieved with only Local Anesthetic agent in 18 (48.6%) cases, whereas in 13 (35.1%) cases a combination of Local Anesthetic agent and sedation.

Conclusion

Tongue lacerations are not very common in the southeast of Nigeria, and management in children may require sedation. Treatment could involve suturing the wound or being left alone to heal.

Primary minor salivary gland tumors: A retrospective review of cases seen in a tertiary institution in South East Nigeria

Background

Tumors of the minor salivary glands (MSGs) are rare. They constitute a wide range of histologic types despite their low frequency.

Aim

The aim of this study is to evaluate the clinical and pathological features of 11 different tumors of MSGs presented at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu and to compare them with similar studies done elsewhere.

Patients and Method

This is a retrospective study of patients with tumors involving the MSGs seen at the OMFS and ORL clinics, UNTH. Information regarding demographic characteristics, duration at first presentation, types of tumors, site and side affected, and treatment given were recorded in patients' medical records. Data were analyzed using SPSS version 23; qualitative variables were compared using Chi-square test.

Result

One hundred and thirty three cases of various lesions involving the salivary gland were seen within the study period. Fifty three (39.8%) patients met the inclusion criteria and are reported further. Twenty eight (28) cases occurred in males. The mean age of the patients was 39.8 years STD 16.5, while the mean duration of the swellings at presentation was 45.5 months STD 35.4. Pleomorphic adenoma was the most common of the 29 (54.7%) benign histopathologic type seen. The soft palate was the commonest site affected 37 (69.8%). Local excision with wide margin was adequate in treating majority of the swellings 40 (75.5%), while 1 (1.9%) case of recurrence was seen within the study period.

Conclusion

Tumors involving the MSGs are uncommon; males are mostly affected in our environment.

Ameloblastoma of the jaws in children: an evaluation of cases seen in a tertiary hospital in South-Eastern Nigeria

Background

Ameloblastoma is one of the most common benign odontogenic tumours in Nigeria. It is considered uncommon in children.

Materials and methods

This is a retrospective study of pediatric patients with histopathological diagnosis of ameloblastoma seen over seven years at the Oral and Maxillofacial Surgery Department of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Relevant information was retrieved from patients' records and data obtained were analysed using SPSS version 23, the chi-square test was used to compare qualitative variables, a p-value of <0.05 was considered as significant.

Results

One hundred and thirty-six cases of ameloblastoma in all age groups were seen within the period. Thirty of the cases met the requirement. The mean age of the patients was 14.4 STD 2.03 (range from 10–17) years. Fourteen (46.7%) patients were male while 16 (53.3%) were female giving a ratio of 1:1.1. The duration of the lesion ranged from 3 months to 72 months (mean 15.07 months). Histologically, the follicular type (n=20, 66.7%) constitute the majority, while the clinical types were solid-multicystic (n=18, 60%) and unicystic (n=12, 40%). Enucleation was the treatment of choice in most (n=18, (60%)) of the patients.

Conclusion

Ameloblastoma is relatively uncommon in children, especially those less than ten years of age. The solid-multicystic variety was the predominant type in the children studied. Most patients presented long after the onset of the tumour and enucleation with mechanical curettage produced satisfactory results in these patients.

Funding

None declared

Tinnitus and Its Effect on the Quality of Life of Sufferers: A Nigerian Cohort Study

Objectives To evaluate the quality of life of patients with ongoing tinnitus. Study Design This was a cross-sectional study of patients with ongoing tinnitus. Setting The study was carried out in a tertiary hospital in southeastern Nigeria. Subjects and Methods Subjects are adults who presented to the otorhinolaryngology clinic with tinnitus as their primary complaint. Pure-tone audiometry, tinnitus pitch, and loudness matching were done. The Tinnitus Handicap Inventory (THI) questionnaire was used in assessing their quality of life. Results There were 63 participants within the age range of 16 to 74 years; 20 (31.7%) were male and 43 (68.3%) were female. The mean duration of tinnitus was 26.7 ± 38.1 months. Nineteen (30.2%) participants had bilateral tinnitus while 44 (69.8%) had unilateral tinnitus. The mean THI score was 36.6 ± 19.7. The most reported handicap was anxiety and difficulty with concentration followed by depression and irritability. There was no correlation between the disability shown by the THI score and the age, sex, duration of the tinnitus, the tinnitus pitch, tinnitus loudness, or the laterality of the tinnitus. There was a significant positive correlation between the grade of hearing loss and the level of disability reported in the THI ( P = .01). Conclusion Tinnitus sufferers appear to have poorer quality of life compared with nonsufferers. This quality-of-life affectation is likely to be worse in those with disabling hearing loss but does not appear to be related to their age, sex, symptom duration, or the loudness and pitch of their tinnitus.

Evaluation of Vocal Cord Function Before Thyroidectomy: Experience from a Developing Country

Vocal cord palsy (VCP) is a major complication of thyroidectomy. Some patients have preexisting VCP prompting the need for routine or selective preoperative evaluation of the vocal cords. The study aims at ascertaining the prevalence of preoperative VCP and making appropriate recommendations. This is a retrospective study of all adult patients who had thyroidectomy at the University of Nigeria Teaching Hospital. Case notes of patients who had thyroidectomy at the hospital from July 2010 to June 2015 were retrieved. Variables studied included biodata, duration of goiter, preoperative hoarseness, outcome of indirect laryngoscopy (IDL), histology of specimen, duration of follow-up, and incidence of postoperative hoarseness. Descriptive statistical analysis was done using SPSS version 20. Of the 91 patients aged 21-70 years (mean 42.08 years, SD 15.40), females outnumbered males with a M:F ratio of 1:10.4. Five patients had preoperative hoarseness, but only three had VCP. IDL was done for 25 (27.4%) patients out of which 22 (88.0%) had normal studies while the remaining three (all from the five with hoarseness) had VCP. Histology of the specimens showed malignancy in 10 (11%), benign in 55 (60.4%), and no report in 26 (28.6%). Five of the malignant histology patients showed normal findings on IDL, three had VCP and two had no preoperative IDL. There was no case of asymptomatic VCP. Vocal cord evaluation is recommended for patients with voice symptoms and those with malignant goiter.

The comparison of the pathological data of oropharyngeal masses between HIV and non-HIV patients

CONCLUSION

Although this study did not show higher risk of oropharyngeal malignancy in HIV patients overall, they still had much higher prevalence of NHL as well as HL than HIV negative patients. Presence of cervical lymphadenopathy is unreliable in differentiating malignant oropharyngeal tumours from benign lymphoid hyperplasia in HIV patients.

OBJECTIVES

The aim of this study was to compare the histology of oropharyngeal masses between HIV positive and negative patients.

METHODS

A retrospective review of 119 patients who underwent oropharyngeal biopsies in a tertiary institution between 2007-2014 and whose HIV status was known (HIV positives =47; negatives =72).

RESULTS

Malignancies occurred in 63.8% of HIV patients and 65% of the negative group (p = 0.87). While non-Hodgkin's lymphoma (NHL), squamous cell carcinoma (SCC), and Hodgkin's lymphoma (HL) constituted 40%, 27%, and 17% of malignancies in HIV patients, respectively; in the HIV-negative group, it was 53%, 13%, and 2% for SCC, NHL, and HL, respectively (p = 0.039, 0.017, and 0.035, respectively). Reactive lymphoid proliferation accounted for 82.4% of the benign masses in the HIV positive group. Malignant tumours were recorded more in younger patient in the HIV positive than the negative group (p = 0.001).

Management of esophageal foreign bodies: experience in a developing country

BACKGROUND

The outcome of esophagoscopy for removal of suspected esophageal foreign bodies (EFBs) is dependent on the FB characteristics and the surgeon's experience. This study was conducted to review our experience and highlight challenges in the management of EFBs in a developing country. The value of radiologic signs in FB detection was also evaluated.

METHODS

We conducted a retrospective chart review of 131 patients: 58.8% males and 41.9% females aged 8 months to 64 years, treated for suspected EFBs in our institution over a 13-year period. Statistics were derived by univariate analysis

RESULTS

Foreign bodies were found and retrieved in 118 cases. Coins were the predominant FB in children (35%), and bones (25%) and dentures (17%) were predominant in adults. Plain radiography was highly useful in detecting FBs in children (coins/metals 100%) but less so in adults (bones 25%, dentures 11%). Repeated esophagoscopy attempts were encountered more in patients with impacted sharp objects (85%) and were recorded significantly among trainee surgeons (p = 0.004). Open esophagotomy was carried out in 13 (10%) difficult cases. Major complications including two iatrogenic esophageal perforations and one death occurred following esophagoscopy by trainee surgeons.

CONCLUSIONS

Rigid esophagoscopy is relatively safe and useful procedure in trained hands for removal of EFBs. Management of long-standing EFBs, dentures, and other sharp objects requires the skills of the most experienced members of the surgical team for a successful outcome. Open surgical treatment is unavoidable in cases of irretrievable esophageal FBs or in the presence of esophageal perforation.