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Qiu C, Cui C, Hautefort C, Haehner A, Zhao J, Yao Q, Zeng H, Nisenbaum EJ, Liu L, Zhao Y, Zhang D, Levine CG, Cejas I, Dai Q, Zeng M, Herman P, Jourdaine C, de With K, Draf J, Chen B, Jayaweera DT, Denneny JC, Casiano R, Yu H, Eshraghi AA, Hummel T, Liu X, Shu Y, Lu H. Olfactory and Gustatory Dysfunction as an Early Identifier of COVID-19 in Adults and Children: An International Multicenter Study. Otolaryngol Head Neck Surg 2020; 163:714-721. [PMID: 32539586 PMCID: PMC7298561 DOI: 10.1177/0194599820934376] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the prevalence and characteristics of olfactory or gustatory dysfunction in coronavirus disease 2019 (COVID-19) patients. STUDY DESIGN Multicenter case series. SETTING Five tertiary care hospitals (3 in China, 1 in France, 1 in Germany). SUBJECTS AND METHODS In total, 394 polymerase chain reaction (PCR)-confirmed COVID-19-positive patients were screened, and those with olfactory or gustatory dysfunction were included. Data including demographics, COVID-19 severity, patient outcome, and the incidence and degree of olfactory and/or gustatory dysfunction were collected and analyzed. The Questionnaire of Olfactory Disorders (QOD) and visual analog scale (VAS) were used to quantify olfactory and gustatory dysfunction, respectively. All subjects at 1 hospital (Shanghai) without subjective olfactory complaints underwent objective testing. RESULTS Of 394 screened subjects, 161 (41%) reported olfactory and/or gustatory dysfunction and were included. Incidence of olfactory and/or gustatory disorders in Chinese (n = 239), German (n = 39), and French (n = 116) cohorts was 32%, 69%, and 49%, respectively. The median age of included subjects was 39 years, 92 of 161 (57%) were male, and 10 of 161 (6%) were children. Of included subjects, 10% had only olfactory or gustatory symptoms, and 19% had olfactory and/or gustatory complaints prior to any other COVID-19 symptom. Of subjects with objective olfactory testing, 10 of 90 demonstrated abnormal chemosensory function despite reporting normal subjective olfaction. Forty-three percent (44/102) of subjects with follow-up showed symptomatic improvement in olfaction or gustation. CONCLUSIONS Olfactory and/or gustatory disorders may represent early or isolated symptoms of severe acute respiratory syndrome coronavirus 2 infection. They may serve as a useful additional screening criterion, particularly for the identification of patients in the early stages of infection.
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Affiliation(s)
- Chenghao Qiu
- Center of Stomatology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Chong Cui
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Charlotte Hautefort
- Department of Head and Neck Surgery, Hopital Lariboisiere, University of Paris, Paris, France
| | - Antje Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Jun Zhao
- Center of Pediatrics, Shanghai Public Health Clinical Center, Shanghai, China
| | - Qi Yao
- Department of Otorhinolaryngology, Chinese and Western Medicine Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Zeng
- Department of Cardiovascularology, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Eric J. Nisenbaum
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Li Liu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai, China
| | - Yu Zhao
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Di Zhang
- Department of Otolaryngology, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Corinna G. Levine
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ivette Cejas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Qi Dai
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Mei Zeng
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Philippe Herman
- Department of Head and Neck Surgery, Hopital Lariboisiere, University of Paris, Paris, France
| | - Clement Jourdaine
- Department of Head and Neck Surgery, Hopital Lariboisiere, University of Paris, Paris, France
| | - Katja de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Julia Draf
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Bing Chen
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Dushyantha T. Jayaweera
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - James C. Denneny
- American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
| | - Roy Casiano
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hongmeng Yu
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Adrien A. Eshraghi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Xuezhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yilai Shu
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai, China
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Qiu C, Cui C, Hautefort C, Haehner A, Zhao J, Yao Q, Zeng H, Nisenbaum EJ, Liu L, Zhao Y, Zhang D, Levine CG, Cejas I, Dai Q, Zeng M, Herman P, Jourdaine C, de With K, Draf J, Chen B, Jayaweera DT, Denneny JC, Casiano R, Yu H, Eshraghi AA, Hummel T, Liu X, Shu Y, Lu H. Olfactory and Gustatory Dysfunction as An Early Identifier of COVID-19 in Adults and Children: An International Multicenter Study. medRxiv 2020. [PMID: 32511546 DOI: 10.1101/2020.05.13.20100198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluate the prevalence and characteristics of olfactory or gustatory dysfunction in COVID-19 patients Study Design: Multicenter Case Series Setting: 5 tertiary care hospitals (3 in China, 1 in France, 1 in Germany) Subjects and Methods: 394 PCR confirmed COVID-19 positive patients were screened, and those with olfactory or gustatory dysfunction were included. Data including demographics, COVID-19 severity, patient outcome, and the incidence and degree of olfactory and/or gustatory dysfunction were collected and analyzed. The Questionnaire of Olfactory Disorders (QOD) and Visual Analogue Scale (VAS) were used to quantify olfactory and gustatory dysfunction respectively. All subjects at one hospital (Shanghai) without subjective olfactory complaints underwent objective testing. RESULTS Of 394 screened subjects, 161 (41%) reported olfactory and/or gustatory dysfunction and were included. Incidence of olfactory and/or gustatory disorders in Chinese (n=239), German (n=39) and French (n=116) cohorts were 32%, 69%, and 49% 138 respectively. The median age of included subjects was 39 years old, 92/161 (57%) were male, and 10/161 (6%) were children. Of included subjects, 10% had only olfactory or gustatory symptoms, and 19% had olfactory and/or gustatory complaints prior to any other COVID-19 symptom. Of subjects with objective olfactory testing, 10/90 demonstrated abnormal chemosensory function despite reporting normal subjective olfaction. 43% (44/102) of subjects with follow-up showed symptomatic improvement in olfaction or gustation. CONCLUSIONS Olfactory and/or gustatory disorders may represent early or isolated symptoms of SARS-CoV-2 infection. They may serve as a useful additional screening criterion, particularly for the identification of patients in the early stages of infection.
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Sampson WWL, Khan SA, Nisenbaum EJ, Kralik JD. Abstraction promotes creative problem-solving in rhesus monkeys. Cognition 2018; 176:53-64. [PMID: 29547710 DOI: 10.1016/j.cognition.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/16/2017] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
Abstraction allows us to discern regularities beyond the specific instances we encounter. It also promotes creative problem-solving by enabling us to consider unconventional problem solutions. However, the mechanisms by which this occurs are not well understood. Because it is often difficult to isolate human high-level cognitive processes, we utilized a nonhuman primate model, in which rhesus monkeys appear to use similar processes to consider an unconventional solution to the difficult reverse-reward problem: i.e., given the choice between a better and worse food option they must select the worse one to receive the better one. After solving this problem with only one specific example-one vs. four half-peanuts-three of four monkeys immediately transferred to novel cases: novel quantities, food items, non-food items, and to the choice between a larger, but inferior vegetable and a smaller, but superior food item (either grape or marshmallow), in which they selected the inferior vegetable to receive the superior option. Thus, we show that nonhuman animals have the capacity to comprehend abstract non-perceptual features, to infer them from one specific case, and to use them to override the natural preference to select the superior option. Critically, we also found that three monkeys had a large learning and performance advantage over the fourth monkey who showed less generalization from the original one and four half-peanuts. This difference suggests that abstraction promoted problem-solving via cascading activation from the two food item options to the relation between them, thus providing access to an initially nonapparent problem solution.
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Affiliation(s)
- William W L Sampson
- Department of Psychological and Brain Sciences, Dartmouth College, 6207 Moore Hall, Hanover, NH 03755, United States
| | - Sara A Khan
- Department of Psychological and Brain Sciences, Dartmouth College, 6207 Moore Hall, Hanover, NH 03755, United States
| | - Eric J Nisenbaum
- Department of Psychological and Brain Sciences, Dartmouth College, 6207 Moore Hall, Hanover, NH 03755, United States
| | - Jerald D Kralik
- Department of Psychological and Brain Sciences, Dartmouth College, 6207 Moore Hall, Hanover, NH 03755, United States; Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon 34141, South Korea.
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Abstract
Mild traumatic brain injury (mTBI), although often presenting without the gross structural abnormalities seen in more severe forms of brain trauma, can nonetheless result in lingering cognitive and behavioral problems along with subtle alterations in brain structure and function. Repeated injuries are associated with brain atrophy and dementia in the form of chronic traumatic encephalopathy (CTE). The mechanisms underlying these dysfunctions are poorly understood. There is a growing body of evidence that brain iron is abnormal after TBI, and brain iron has also been implicated in a host of neurodegenerative disorders. The purpose of this article is to review evidence about the function of iron in the pathophysiology of mTBI and the role that advanced imaging modalities can play in further elucidating said function. MRI techniques sensitive to field inhomogeneities provide supporting evidence for both deep gray matter non-heme iron accumulation as well as focal microhemorrhage resulting from mTBI. In addition, there is evidence that iron may contribute to pathology after mTBI through a number of mechanisms, including generation of reactive oxygen species (ROS), exacerbation of oxidative stress from other sources, and encouragement of tau phosphorylation and the formation of neurofibrillary tangles. Finally, recent animal studies suggest that iron may serve as a therapeutic target in mitigating the effects of mTBI. However, research on the presence and role of iron in mTBI and CTE is still relatively sparse, and further work is necessary to elucidate issues such as the sources of increased iron and the chain of secondary injury.
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Affiliation(s)
- Eric J Nisenbaum
- Department of Radiology, NYU Langone Medical Center , New York, New York
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