Acute-onset smell and taste disorders in the context of COVID-19: a pilot multicentre polymerase chain reaction based case-control study.

BACKGROUND AND PURPOSE: Specific respiratory tract infections, including COVID-19, may cause smell and/or taste disorders (STDs) with increased frequency. The aim was to determine whether new-onset STDs are more frequent amongst COVID-19 patients than influenza patients. METHOD: This was a case-control study including hospitalized patients of two tertiary care centres. Consecutive patients positive for COVID-19 polymerase chain reaction (cases) and patients positive for influenza polymerase chain reaction (historical control sample) were assessed during specific periods, employing a self-reported STD questionnaire. RESULTS: Seventy-nine cases and 40 controls were included. No significant differences were found in basal features between the two groups. New-onset STDs were significantly more frequent amongst cases (31, 39.2%) than in the control group (5, 12.5 %) [adjusted odds ratio 21.4 (2.77-165.4, P = 0.003)]. COVID-19 patients with new-onset STDs were significantly younger than COVID-19 patients without STDs (52.6 ± 17.2 vs. 67.4 ± 15.1, P < 0.001). Amongst COVID-19 patients who presented STDs, 22 (70.9%) recalled an acute onset and it was an initial manifestation in 11 (35.5%). Twenty-five (80.6%) presented smell disorders (mostly anosmia, 14, 45.2%) and 28 (90.3%) taste disorders (mostly ageusia, 14, 45.2%). Only four (12.9 %) reported concomitant nasal obstruction. The mean duration of STD was 7.5 ± 3.2 days and 12 patients (40%) manifested complete recovery after 7.4 ± 2.3 days of onset. CONCLUSION: New-onset STDs were significantly more frequent amongst COVID-19 patients than influenza patients; they usually had an acute onset and were commonly an initial manifestation. The use of STD assessment in anamnesis as a hint for COVID-19 and to support individuals' self-isolation in the current epidemic context is suggested.

Evaluation of prenucleic acid extraction for increasing sensitivity of detection of virus in bovine follicular fluid pools.

Bovine viral diarrhea virus (BVDV), bovine herpesvirus type 1 (BoHV-1), and bovine herpesvirus type 5 (BoHV-5) are major cattle pathogens that can be present in biological materials used in assisted reproduction biotechnologies. The aim of the present study was to increase the sensitivity of the polymerase chain reaction (PCR) for detection of BVDV, BoHV-1, and BoHV-5 in bovine follicular fluid (FF) collected during oocyte retrieval for in vitro embryo production. Ovaries were collected immediately after slaughter at a commercial abattoir, aspirated, and the 7336 samples of FF were pooled in 84 samples. Before testing the FF field samples, sensitivity of the protocol was determined using a prenucleic acid extraction procedure that was directly compared with standard RNA or DNA extraction protocols. The prenucleic acid extraction procedure increased sensitivity of reverse transcription (RT)-PCR for BVDV and nested PCR for BoHV-1 and BoHV-5 by 100 and 10 times, respectively. The 84 FF pools were assayed for BVDV, BoHV-1, and BoHV-5 using virus isolation and RT-PCR or nested PCR. Fourteen (16.7%) FF pools were positive for BVDV RNA, and one (1.2%) was positive for BoHV-1 DNA. Two of the BVDV RT-PCR positive samples and the one BoHV-1 PCR positive sample were also positive in cell culture, demonstrating that FF contained infectious viruses. In this study, the prenucleic acid extraction procedure increased the sensitivity of RT-PCR and PCR detection. This study highlighted the importance of assuring biosecurity by detecting the presence of viral pathogens in biological materials used during in vitro embryo production.

Pregnancy outcome in inflammatory bowel disease: prospective European case-control ECCO-EpiCom study, 2003-2006.

BACKGROUND: Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies. AIM: To evaluate the pregnancy outcome in patients with IBD in a prospective European multicentre case-control study. METHODS: Inflammatory bowel disease pregnant women from 12 European countries were enrolled between January 2003 and December 2006 and matched (1:1) to non-IBD pregnant controls by age at conception and number of previous pregnancies. Data on pregnancy and newborn outcome, disease activity and therapy were prospectively collected every third month using a standard questionnaire. Logistic regression analysis with odds ratio was used for statistical analyses. P value<0.05 was considered significant. RESULTS: A total of 332 pregnant women with IBD were included: 145 with Crohn's disease (CD) and 187 with ulcerative colitis (UC). Median age (range) at conception was 31 years (15-40) in CD and 31 (19-42) in UC patients. No statistically significant differences in frequency of abortions, preterm deliveries, caesarean sections, congenital abnormalities and birth weight were observed comparing CD and UC women with their non-IBD controls. In CD, older age was associated with congenital abnormalities and preterm delivery; smoking increased the risk of preterm delivery. For UC, older age and active disease were associated with low birth weight; while older age and combination therapy were risk factors for preterm delivery. CONCLUSION: In this prospective case-control study, women with either Crohn's disease or ulcerative colitis have a similar pregnancy outcome when compared with a population of non-inflammatory bowel disease pregnant women.

Effects of cardiac rehabilitation on atrial wave in patients after myocardial infarction.

Cardiac rehabilitation (CR) can improve cardiac hemodynamic performance in patients after myocardial infarction (MI). Little evidence is provided concerning the consequences of CR on atrial wave duration, and less is known about the link between pre-arrhythmogenic patterns and the cardiovascular performance improvement in these subjects. Twenty-six patients, post-MI 0 to 7 days, underwent a complete CR cycle and a signal-averaged electrocardiogram (SAECG) for the evaluation of atrial activation parameters (group 1) to appreciate if physical training can promote parallel improvement in cardiovascular and intra-atrial conduction parameters. A control group of 24 well-matched nonischemic subjects (group 2) was chosen for data comparison. Resting heart rate (p < 0.01) and resting double product (p < 0.01) decreased after CR in groups 1 and 2, while diastolic blood pressure at maximal stress was decreased in group 1 (p < 0.01) with a parallel increase in the time of physical training (p < 0.05). SAECG parameters of atrial activation were unchanged in group 1 after the comparison and only total atrial duration activation (dA) reached statistical significance (113.3 +/- 17.2 msec vs 120.8 +/- 14.2 msec, subjects after CR vs before CR, p < 0.01). CR could improve intra-atrial activation in subjects after MI, but the consequences of hemodynamic adjustment of the trained heart must undergo a more accurate evaluation to verify if CR can prevent adverse arrhythmogenic complications of MI through cardiovascular performance improvement.

[Azithromycin versus amoxicillin in triple therapy for the treatment of Helicobacter pylori infection]. / Azitromicina versus amoxicillina in tripla terapia nel trattamento eradicante Helicobacter pylori.

BACKGROUND: To establish if azithromycin, in association with omeprazole and metronidazole, is effective to eradicate Helicobacter pylori, compared to amoxicillin in triple therapy. METHODS: Two hundred consecutive patients with duodenal ulcer and Helicobacter pylori infection were enrolled in the study: group a) 100 patients (69 males, 31 females; mean age 47.61 years; range 23-75); group b) 100 patients (70 males, 30 females; mean age 45.56 years; range 22-72). Group a) omeprazole 20 mg od, azithromycin 500 mg od the first three and the last three days of association with metronidazole, this one 250 mg qid, for ten days; group b) omeprazole 20 mg od, amoxicillin 1 g bid, metronidazole 250 mg qid for ten days. Omeprazole was continued for other four weeks in each treatment with the same dosage. RESULTS: In group a ulcer healing was observed in 89 patients (89 %), while in group b in 93 patients (93%) (p=n.s.). Helicobacter pylori infection was eradicated in group a in 70 patients (70 %), while in group b in 78 patients (78 %) (p=n.s.). Side effects in 11 patients (5.5 %), in particular: group a 5 (5 %), group b 6 (6 %) (p=n.s.). CONCLUSIONS: Azithromycin could be proposed for treatment of Helicobacter pylori eradication.

[Endoscopy of the upper digestive tract in anti-HIV positive subjects]. / L'endoscopia del tratto digestivo superiore in soggetti anti-HIV positivi.

BACKGROUND: The aim of our study was to evaluate any correlation between symptoms of the upper digestive tract, endoscopic findings and the clinical stage of disease. METHODS: Thirty-four anti-HIV positive patients were enrolled and subdivided, according to CDC classification, as follows: 28 CDC II/III (asymptomatics) and 6 CDC IV (AIDS). The past medical history of all patients was investigated and oesophagogastroduodenoscopy (OGDS) was carried out. RESULTS: All anti-HIV positive patients complained of gastrointestinal symptoms (100%), while endoscopic lesions were observed in 11/34 (32.3%). CONCLUSIONS: The data did not show any correlation between symptoms and endoscopic alterations; we showed more frequent endoscopic alteration in CDC IV patients, even if being treated, compared with CDC II/III.

Prolonged treatment of chronic C hepatitis by means of medium-high doses of recombinant alpha-2b interferon: an open study to evaluate response and long-term relapse.

Thirty-six patients with hepatitis C virus-RNA positive chronic hepatitis were studied to evaluate whether recombinant alpha-2b interferon, in medium-high doses, (6-9 MU 3 times/week) over a long period (12-18 months), was more effective in reducing or normalizing alanine aminotransferase values, and in reducing the relapsing percentage than the historical trials. At the end of the 12th and 18th month of treatment, mean alanine aminotransferase values were significantly reduced; the level of complete responses was 36.1%, at the end of the 12th month, and 19.4% at the end of the 18th month (intention to treat). These results were no better than comparable findings in the literature. At the end of the first follow-up (12th month), percent complete responses fell to 15.5%, with a relapse rate of 14.3%. At the end of the second follow-up (24th month), percent complete responses fell further to 11.1% (all 4 patients with a 24 months sustained response showed absence of viraemia), with a relapse rate of 42.9%; even these percentages were judged unsatisfactory. In conclusion, no significant advantage was obtained by prolonging interferon treatment and/or using higher dosages. However, the possible virus clearance in all the long-term responders seems to justify further investigation in terms of cost-benefit analysis.

Empty sella syndrome and growth deficiency in childhood.

We describe four cases of empty sella syndrome in childhood associated with growth and neuroendocrine disorders. We note that empty sella syndrome probably presents with endocrine disorders more often in childhood than in adults and that its frequency seems to be underestimated.

Lactose malabsorption and intolerance in Italians. Clinical implications.

Lactose malabsorption was assessed by the hydrogen breath test in 40 Italian patients with irritable bowel syndrome and 42 controls without abdominal disturbances. Sixty-five percent of patients were "low milk consumers" (0-250 ml milk per day) compared with 38% of controls (P less than 0.02). Lactose loads of 25 and 50 g caused malabsorption in 82.5 and 87.5% patients and in 55 and 62% controls, respectively (patients vs controls P less than 0.02). Malabsorption was more frequent in the "low milk consumers" group (P less than 0.05). During a four-month lactose-free diet as the only treatment 7.5% of patients became symptom-free (and remained so for a further eight-month diet), 52.5% improved, and 40% showed no change.