Recent Smell Loss Is the Best Predictor of COVID-19 Among Individuals With Recent Respiratory Symptoms.

In a preregistered, cross-sectional study, we investigated whether olfactory loss is a reliable predictor of COVID-19 using a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n = 4148) or negative (C19-; n = 546) COVID-19 laboratory test outcome. Logistic regression models identified univariate and multivariate predictors of COVID-19 status and post-COVID-19 olfactory recovery. Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean ± SD, C19+: -82.5 ± 27.2 points; C19-: -59.8 ± 37.7). Smell loss during illness was the best predictor of COVID-19 in both univariate and multivariate models (ROC AUC = 0.72). Additional variables provide negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms (e.g., fever). Olfactory recovery within 40 days of respiratory symptom onset was reported for ~50% of participants and was best predicted by time since respiratory symptom onset. We find that quantified smell loss is the best predictor of COVID-19 amongst those with symptoms of respiratory illness. To aid clinicians and contact tracers in identifying individuals with a high likelihood of having COVID-19, we propose a novel 0-10 scale to screen for recent olfactory loss, the ODoR-19. We find that numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (4 < OR < 10). Once independently validated, this tool could be deployed when viral lab tests are impractical or unavailable.

Global study of variability in olfactory sensitivity.

Variability in human olfactory sensitivity has been attributed to individual-level factors such as genetics, age, sex, medical history of infections and trauma, neurogenerative diseases, and emotional disorders. Scarce evidence exists on the cross-cultural variation in olfactory sensitivity. Hence, we performed 2 studies to estimate the variability in olfactory threshold as a function of location and environment. Study 1 involved 11 laboratories from 4 continents (N = 802). In each location, in a designated laboratory, approximately 80 subjects underwent olfactory sensitivity testing with custom-made tests with eucalyptol and phenylethanol (PEA) odors. Tests were based on the Threshold subtest of the Sniffin' Sticks battery. In Study 2, we compared olfactory sensitivity and suprathreshold perception of PEA and eucalyptol in 2 Chinese (N = 160) and 2 Indian (N = 92) populations-one based in their native country and the other in Germany. Both studies present large-scale evidence that olfactory sensitivity varies as a function of geographical location and suggest that environmental factors play an important role in shaping olfactory sensitivity and suprathreshold olfactory perception. We delineate further steps necessary to identify specific factors underlying uncovered variability and the relationship between olfactory sensitivity and suprathreshold odor perception. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The best COVID-19 predictor is recent smell loss: a cross-sectional study.

BACKGROUND: COVID-19 has heterogeneous manifestations, though one of the most common symptoms is a sudden loss of smell (anosmia or hyposmia). We investigated whether olfactory loss is a reliable predictor of COVID-19. METHODS: This preregistered, cross-sectional study used a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified singular and cumulative predictors of COVID-19 status and post-COVID-19 olfactory recovery. RESULTS: Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean±SD, C19+: -82.5±27.2 points; C19-: -59.8±37.7). Smell loss during illness was the best predictor of COVID-19 in both single and cumulative feature models (ROC AUC=0.72), with additional features providing no significant model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms, such as fever or cough. Olfactory recovery within 40 days was reported for ~50% of participants and was best predicted by time since illness onset. CONCLUSIONS: As smell loss is the best predictor of COVID-19, we developed the ODoR-19 tool, a 0-10 scale to screen for recent olfactory loss. Numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (10

[Risk markers of follicular neoplasms in thyroid nodules]. / Marcadores de riesgo de neoplasia folicular en nódulos tiroideos.

Thyroid nodules of follicular origin include neoplastic and non neoplastic processes. No methods of diagnosis or cytological features (obtained by fine-needle aspiration, FNA) may differentiate both types, and therefore differential diagnosis still constitutes a dilemma.We analyzed the existing association between clinical variables and methods of diagnosis in thyroid nodules of follicular type with the aim of defining risk of neoplasm. Ninety two patients with nodular goiters, of follicular origin by cytology, previously submitted to surgical treatment were analyzed. The studied variables were: sex, age, size of the nodule, ultrasound characteristics, cytological diagnosis, TSH level and results of the scintigraphy. Of 92 cases, 74 were neoplastic nodules (56 adenomas and 18 differentiated thyroid cancer) and 18 were non neoplastic nodules. Markers, that were related to high risk of follicular neoplasm corresponded to the cytological diagnosis of proliferation of high follicular degree, in iso or hypoechoic, and hypofunctioning nodules with I131. The carcinomas presented cytology of follicular proliferation of high degree, in hipoechoic nodules, of irregular edges with microcalcifications and hypofunctioning, in male patients or patients younger than 20 years. The presence of macrocalcifications and hypercaptation would be in favor of nodules of benign origin.The correlation of diagnostic methods and clinical variables in thyroid nodules of follicular type would allow us to differentiate the risk of neoplasm or carcinoma, and plan surgical selective treatments.

[Non-incidental papillary microcarcinomas of the thyroid]. / Microcarcinomas papilares de tiroides no incidentales.

The clinical significance of papillary microcarcinoma of the thyroid gland keeps being controversial. Its high prevalence in autopsies and as incidental findings in thyroidectomy specimens for benign pathology indicate an indolent clinical behavior. Nevertheless some of the microcarcinomas develop lymph node metastasis and local recurrence. To determine the clinical and pathological characteristics of non-incidental papillary microcarcinomas of the thyroid (PTM -NI). 18 patients with diagnosis of non-incidental papillary microcarcinoma (tumor < or = 1 cm) with nodular expression in the thyroid gland or with lymph node metastasis have been studied. Initial diagnosis, prediction factors and evolution have been evaluated. Of 18 patients with PTM-NI, 12 demonstrated lymph node metastasis. 6 patients had positive fine needle aspiration (FNA) of palpable thyroid nodules. Multifocality and extraglandular extension were associated with lymph node metastasis. Seven of the nine metastatic lymph nodes diagnosed by FNA were cystic. Histologically 83.3% of the nodules in the thyroid were non-encapsulated and showed papillary growth pattern. Multifocality and extrathyroid infiltration were associated with lymph node metastasis at presentation. 46% of the patients with thyroid nodules > or = 4 mm and lymph node involvement (N1) showed recurrence/persistence. The non-incidental intrathyroideal papillary microcarcinoma without capsular involvement, extraglandular extension or lymph node metastasis (N0) did not demonstrate recurrence. These results suggest two groups of non- incidental papillary microcarcinoma of the thyroid (PMT-NI), one intraglandular without risk of evolution -N0- and other extraglandular at risk of recurrence -N1-.

Abordaje integral en la rehabilitación funcional del olfato y del gusto desde un enfoque fonoaudiológico / Recovering the sense of taste and smell as a result of opperational therapy integration -speech-pathology-based approach / Abordagem integral na reabilitação funcional do olfato e do paladar a partir de um enfoque fonoaudiologico

Introducción: teniendo en cuenta la ontogenia y la antropología del olfato y del gusto del individuo, la Rehabilitación Fonoaudiológica del Olfato y Gustose ha encarado desde un punto de vista funcional y de integración de ambos sentidos, mediante la Estimulación Integral Multisensorial, teniendo en cuentatanto la vía retro como la ortonasal. Objetivo: Demostrar los resultados obtenidos con el uso de la rehabilitación fonoaudiológica del olfato y gusto, mediante la estimulación integral multisensorial. Materiales y métodos: Estudio descriptivo observacional longitudinal de junio a octubre de 2015 de 7 casos (2 hombres y 5 mujeres) diagnosticados pormédico otorrinolaringólogo especialista en olfato y gusto del Hospital de Clínicas José de San Martín. Se tomó una historia clínica detallada, se administró el Test de Connecticut, pre y pos rehabilitación y se aplicó el Protocolo de Rehabilitación para pacientes con Trastornos de Olfato y Gusto. Resultados: En cuanto a la evaluación objetiva, 4 de los 7 pacientes pasaron de anosmia a hiposmia severa. Un sujeto evolucionó de hiposmia moderada a leve después de rehabilitación fonoaudiológica exclusiva. Dos pacientes no lograron salir de la anosmia. Uno de ellos presentó cambios subjetivos luego de un mes de tratamiento que, debido a un cuadro de vías aéreas superiores, desaparecieron. Conclusiones: 5 de los 7 pacientes mostraron resultados positivos al tratamiento, lo que demostraría que la estimulación de la vía retro y ortonasal en conjunto con la Estimulación Integral Multisensorial, llevaría a progresos significativos.

Introduction: considering Ontogeny and anthropological aspects of the individual’s sense of smell and taste, Speech Therapy is addressed by means of multi-sensory integration of orto-nasal and retronasal ways, in which both senses are operationally integrated. Objectives: Demostrate the results obtained using Speech Therapy of smell and taste, through integrated multisensory stimulation. Methods and materials: Descriptive observational longitudinal study of seven cases analyzed from June to October, 2015. Two men and five women were diagnosed by an otorhinolaryngologist specializing in smell and taste disorders. The patients’ medical history,was used for the purposes of this study. The Connecticut Test and “El Protocolo de Rehabilitaciónpara Pacientes con Trastornos de Olfato y Gusto” (“Examination Protocol for Patients Diagnosed with Smell and Taste Disorders”) were applied. Results: After applying the tests, four out of seven patients who suffered from anosmia, were eventually diagnosed with severe hyposmia. One subject developed with mild hyposmia after receiving Speech Therapy exclusively. Two patients were not able to recover from anosmia. In one of them, subjective improvements were observed after one month of treatment; however they completely dissappeared later, due to an upper respiratory tract inffection. Conclusions: Improvements were observed in five of the cases analyzed thanks to the treatment administered. Thus, the combination of retro-nasal and orto-nasal ways stimulation and multi-sensory integration is supposed to significantly improve the well-being of patients diagnosed with anosmia.

Introdução: tendo em conta a ontogenia e a antropologia do olfato e do paladar do indivíduo, a Reabilitação Fonoaudiológica do Olfato e do Paladar foi desenvolvida a partir de um ponto funcional e da interação de ambos os sentidos, por meio de Estimulação Integral Multissensorial, tomando-se em conta tanto a via retro como a ortonasal. Objetivo: Demonstrar resultados usando a reabilitação fonoaudiológica de olfato e paladar , através da estimulação multisensorial integrado. Materiais e métodos: Estudo longitudinal descritivo observacional de junho a outubro de 2015 de sete casos (dois homens e cinco mulheres) diagnosticados por médico Otorrinolaringologista especialista em olfato e paladar do Hospital de Clínicas José de San Martín. A partir de uma história clínica detalhada, foi administrado o Teste Connecticut, pré e pós-reabilitação e aplicado o Protocolo de Reabilitação para pacientes com Transtornos de Olfato e Paladar. Resultados: Em relação à avaliação objetiva, quatro dos sete pacientes passaram de anosmia à hiposmia severa. Um paciente evoluiu de hiposmia moderada à leve depois da reabilitação fonoaudiológica exclusiva. Dois pacientes não conseguiram sair da anosmia. Um deles apresentou mudanças subjetivas depois de um mês de tratamento, mas devido a um quadro de vias aéreas superiores, as mudanças desapareceram. Conclusão: Cinco de sete pacientes mostraram resultados positivos ao tratamento, o que demonstraria que a estimulação da via aérea retro e ortonasal em conjunto com a Estimulação Integral Multissensorial, poderia levar a progressos significativos.

Marcadores de riesgo de neoplasia folicular en nódulos tiroideos / Risk markers of follicular neoplasms in thyroid nodules

Los nódulos tiroideos de origen folicular abarcan procesos no neoplásicos y neoplásicos. No existen métodos de diagnóstico ni rasgos citológicos por punción con aguja fina (PAF) que los delimiten, constituyendo un dilema su diagnóstico diferencial. Analizamos la asociación existente entre variables clínicas y métodos de diagnóstico prequirúrgicos en nódulos tiroideos de estirpe folicular, con el objetivo de definir riesgo de neoplasia.Se estudiaron 92 pacientes con bocios nodulares de estirpe folicular por citología, tratados con tiroidectomía. Las variables analizadas fueron: sexo, edad, tamaño del nódulo, características ecográficas, diagnóstico citológico, nivel de TSH y resultados del centellograma. De los 92 casos, 74 fueron neoplásicos (56 adenomas y 18 carcinomas diferenciados) y 18 nódulos no neoplásicos, hiperplásicos o adenomatosos. Los marcadores que se relacionaron con alto riesgo de neoplasia folicular correspondieron al diagnóstico citológico de proliferación folicular de alto grado, en nódulos iso o hipoecogénicos, e hipocaptantes con I131. Los carcinomas presentaron citología de proliferación folicular de alto grado en nódulos hipoecogénicos, de bordes irregulares con microcalcificaciones e hipocaptantes, en pacientes varones o menores de 20 años. La presencia de macrocalcificaciones e hipercaptación estarían a favor de nódulo de origen benigno.La correlación de los métodos de diagnóstico y variables clínicas en nódulos tiroideos de estirpe folicular nos permitirían delimitar el riesgo de neoplasia y carcinoma para planificar un tratamiento quirúrgico selectivo.

Thyroid nodules of follicular origin include neoplastic and non neoplastic processes. No methods of diagnosis or cytological features (obtained by fine-needle aspiration, FNA) may differentiate both types, and therefore differential diagnosis still constitutes a dilemma.We analyzed the existing association between clinical variables and methods of diagnosis in thyroid nodules of follicular type with the aim of defining risk of neoplasm. Ninety two patients with nodular goiters, of follicular origin by cytology, previously submitted to surgical treatment were analyzed. The studied variables were: sex, age, size of the nodule, ultrasound characteristics, cytological diagnosis, TSH level and results of the scintigraphy. Of 92 cases, 74 were neoplastic nodules (56 adenomas and 18 differentiated thyroid cancer) and 18 were non neoplastic nodules. Markers, that were related to high risk of follicular neoplasm corresponded to the cytological diagnosis of proliferation of high follicular degree, in iso or hypoechoic, and hypofunctioning nodules with I131. The carcinomas presented cytology of follicular proliferation of high degree, in hipoechoic nodules, of irregular edges with microcalcifications and hypofunctioning, in male patients or patients younger than 20 years. The presence of macrocalcifications and hypercaptation would be in favor of nodules of benign origin.The correlation of diagnostic methods and clinical variables in thyroid nodules of follicular type would allow us to differentiate the risk of neoplasm or carcinoma, and plan surgical selective treatments.

Microcarcinomas papilares de tiroides no incidentales / Non-incidental papillary microcarcinomas of the thyroid

El significado clínico de los microcarcinomas papilares de tiroides sigue siendo controvertido. La alta prevalencia en autopsias e incidental en tiroidectomías por patología benigna indican un comportamiento clínico indolente. Sin embargo, algunos desarrollan metástasis ganglionares y recurrencia local. Nuestro objetivo fue determinar características clínicas y patológicas de microcarcinonas papilares de tiroides no incidentales (MPT-NI). Se analizaron 18 pacientes con diagnóstico de microcarcinomas (tumor < 1cm) MPTNI con expresión nodular o metastásica. Se evaluaron características clínicas, histopatológicas, pronósticas y evolutivas. De los 18 pacientes con MPT-NI, 12 manifestaron expresión ganglionar inicial. En los 6 restantes, los nódulos tiroideos fueron palpables con PAAF (punción aspiración con aguja fina) positiva. La multicentricidad e infiltración extratiroidea se asoció con metástasis ganglionares en todos los casos. De los 9 diagnósticos por PAAF de metástasis ganglionares, 7 fueron quísticas. En los estudios histológicos el 83.3% de los nódulos fueron no encapsulados, con patrón de papilar clásico predominante. En la evolución, la recurrencia se manifestó en el 46% de los pacientes N1 o con metástasis ganglionar inicial, en nódulos < 4 mm. La infiltración extratiroidea estuvo presente en el 66% de los casos con recurrencia. No manifestaron recurrencia los pacientes sin compromiso ganglionar (N0) o infiltrativo capsular o extratiroideo. En el seguimiento de 10 a 122 meses todos los pacientes se encuentran libres de enfermedad demostrable. Estos resultados sugieren dos grupos de microcarcinomas tiroideos no incidentales, aquellos sin riesgo de evolución intratiroideos -N0- y con riesgo de recurrencia extratiroideos -N1-.

The clinical significance of papillary microcarcinoma of the thyroid gland keeps being controversial. Its high prevalence in autopsies and as incidental findings in thyroidectomy specimens for benign pathology indicate an indolent clinical behavior. Nevertheless some of the microcarcinomas develop lymph node metastasis and local recurrence. To determine the clinical and pathological characteristics of non-incidental papillary microcarcinomas of the thyroid (PTM -NI). 18 patients with diagnosis of non-incidental papillary microcarcinoma (tumor < 1cm) with nodular expression in the thyroid gland or with lymph node metastasis have been studied. Initial diagnosis, prediction factors and evolution have been evaluated. Of 18 patients with PTM-NI, 12 demonstrated lymph node metastasis. 6 patients had positive fine needle aspiration (FNA) of palpable thyroid nodules. Multifocality and extraglandular extension were associated with lymph node metastasis. Seven of the nine metastatic lymph nodes diagnosed by FNA were cystic. Histologically 83.3% of the nodules in the thyroid were non-encapsulated and showed papillary growth pattern. Multifocality and extrathyroid infiltration were associated with lymph node metastasis at presentation. 46% of the patients with thyroid nodules < 4 mm and lymph node involvement (N1) showed recurrence/persistence. The non-incidental intrathyroideal papillary microcarcinoma without capsular involvement, extraglandular extension or lymph node metastasis (N0) did not demonstrate recurrence. These results suggest two groups of non- incidental papillary microcarcinoma of the thyroid (PMT-NI), one intraglandular without risk of evolution -N0- and other extraglandular at risk of recurrence -N1-.