Evaluation of subjective and tested olfactory dysfunction as a screening tool for COVID-19 in children.

INTRODUCTION: Olfactory dysfunction (OD) is an extremely frequent symptom of SARS-CoV-2 infection in adults. However, the symptomatology in the paediatric population remains understudied and heavily reliant on questionnaires. The aims of this study were to evaluate the prevalence of OD in children with SARS-CoV-2 infection and to assess the use of olfactory testing in predicting COVID-19 in children. Furthermore, we aimed to investigate the correlation between subjective and objective sense of smell in children. METHODS: Children aged 6-12 years presenting at Test Centre Aarhus for a reverse transcription PCR for SARS-CoV-2 were invited to participate during the study period (from 8 January to 22 February 2022). They underwent olfactory testing with Sniffin' Sticks 16 Identification Kit and they were asked about their subjective assessment of smell and any confounding factors. RESULTS: A total of 78 children completed inclusion of whom 51 had a positive SARS-CoV-2 PCR test. We found no correlation between either current SARS-CoV-2 status and Sniffin' Sticks Identification score (p = 0.500) or previous self-reported infection. We also found no correlation between subjective and objective sense of smell (p = 0. 109). CONCLUSION: The lack of correlation between SARS-CoV-2 infection and OD may indicate that OD is not a dominant symptom in children. Therefore, olfactory testing is not recommended as a screening method for SARS-CoV-2 as was suggested in adults. Likewise, subjective questioning is not a reliable tool in assessing olfactory function in children. FUNDING: Laura Danielsen received funding for salary from Forskningsfond Hospitalsenheden Vest (now Forskningsfond Regionshospitalet Gødstrup). Alexander Wieck Fjældstad wishes to acknowledge research salary funding for other projects from Velux Fonden. The sponsors had no say, roles or responsibilities in relation to the study, including (but not limited to) the study design, data collection, management, analysis or decision to publish. TRIAL REGISTRATION: Not relevant.

Chemosensory function and food preferences among haemodialysis patients.

INTRODUCTION: Malnutrition and disturbed sense of smell and taste frequently occur in patients treated with chronic haemodialysis. The common denominator between chemosensation and nutrition may be food preferences. Our aim was to investigate smell and taste function as well as food preferences among haemodialysis patients and compare the results with those of age-matched controls. METHODS: An observational case-control study was conducted on 29 patients on chronic haemodialysis and 39 age-matched healthy controls. Chemosensory function was evaluated using validated gustatory and olfactory tests. Food preferences were recorded using a questionnaire of 63 items including a five-point Likert scale of familiarity, liking and frequency. RESULTS: Chemosensory function was significantly poorer among patients than among controls. Patients had significantly lower familiarity and frequency of consumptions of all food categories than controls and they also had significantly lower liking of vegetables, fruits and starches. CONCLUSIONS: Implementation of the provided knowledge about haemodialysis patients' smell and taste function including their food preferences are suggested, such as enhancement of odorant intensity, use of taste amplification, cooking habits and exposure to more varied food items. Assessments of food preferences and chemosensory function prior to determination of individual dietary schedules are therefore recommended. FUNDING: The authors did not receive any financial support for the research or drafting of this article. The authors declare that they have no financial interests to report. TRIAL REGISTRATION: Danish Ethical Committee project number: M-2018-188-18.

Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry.

OBJECTIVE: To compare baseline disease activity and treatment effectiveness in biologic-naive patients with nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) who initiate tumor necrosis factor inhibitor (TNFi) treatment and to study the role of potential confounders (e.g., HLA-B27 status). METHODS: Observational cohort study based on prospectively registered data in the nationwide DANBIO registry. We used Kaplan-Meier plots, Cox, and logistic regression analyses to study the effect of diagnosis (nr-axSpA vs AS) and potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity) on TNFi adherence and response [e.g., Bath Ankylosing Spondylitis Activity Index (BASDAI) 50%/20 mm]. RESULTS: The study included 1250 TNFi-naive patients with axSpA (29% nr-axSpA, 50% AS, 21% lacked radiographs of sacroiliac joints). Patients with nr-axSpA were more frequently women (50%/27%) and HLA-B27-negative (85/338 = 25%), compared to AS (81/476 = 17%; p < 0.01). At TNFi start patients with nr-axSpA had higher visual analog scale scores [median (quartiles)] for pain: 72 mm (55-84)/65 mm (48-77); global: 76 mm (62-88)/68 mm (50-80); fatigue: 74 mm (55-85)/67 mm (50-80); and BASDAI: 64 (54-77)/59 (46-71); all p < 0.01. However, patients with nr-axSpA had lower C-reactive protein: 7 mg/l (3-17)/11 mg/l (5-22); and BAS Metrology Index: 20 (10-40)/40 (20-50); all p < 0.01. Median (95% CI) treatment adherence was poorer in nr-axSpA than in AS: 1.59 years (1.15-2.02) versus 3.67 years (2.86-4.49), p < 0.0001; but only in univariate and not confounder-adjusted analyses (p > 0.05). Response rates were similar in AS and nr-axSpA (p > 0.05). HLA-B27 negativity was associated with poorer treatment adherence [HLA-B27 negative/positive, nr-axSpA: HR 1.74 (1.29-2.36), AS: HR 2.04 (1.53-2.71), both p < 0.0001]; and lower response rates (nr-axSpA: 18/61 = 30% vs 93/168 = 55%; AS: 17/59 = 29% vs 157/291 = 54%, both p < 0.05). CONCLUSION: In this nationwide cohort, patients with nr-axSpA had higher subjective disease activity at start of first TNFi treatment, but similar outcomes to patients with AS after confounder adjustment. HLA-B27 positivity was associated with better outcomes irrespective of axSpA subdiagnosis.