Smell and Taste Dysfunction in COVID-19 Is Associated With Younger Age in Ambulatory Settings: A Multicenter Cross-Sectional Study.

BACKGROUND AND OBJECTIVE: Since the initial anecdotal reports of coronavirus disease 2019 (COVID-19) from China, a growing number of studies have reported on smell and/or taste dysfunction (STD). Objective: The aim of our study was to investigate the frequency and severity of STD in COVID-19 patients and to evaluate the association with demographic characteristics, hospital admission, symptoms, comorbidities, and blood biomarkers. METHODS: We performed a multicenter cross-sectional study on patients who were positive for SARS-CoV-2 (n=846) and controls (n=143) from 15 Spanish hospitals. Data on STD were collected prospectively using an in-person survey. The severity of STD was categorized using a visual analog scale. We analyzed time to onset, recovery rate, time to recovery, hospital admission, pneumonia, comorbidities, smoking, and symptoms. RESULTS: STD was at least 2-fold more common in COVID-19-positive patients than in controls. COVID-19-positive hospitalized patients were older, with a lower frequency of STD, and recovered earlier than outpatients. Analysis stratified by severity of STD showed that more than half of COVID-19 patients presented severe loss of smell (53.7%) or taste (52.2%); both senses were impaired in >90%. In the multivariate analysis, older age (>60 years), being hospitalized, and increased C-reactive protein were associated with a better sense of smell and/or taste. COVID-19-positive patients reported improvement in smell (45.6%) and taste (46.1%) at the time of the survey; in 90.6% this was within 2 weeks of infection. CONCLUSION: STD is a common symptom in COVID-19 and presents mainly in young and nonhospitalized patients. More studies are needed to evaluate follow-up of chemosensory impairment.

Smell and taste dysfunction in COVID-19 is associated with younger age in ambulatory settings: a multicenter cross-sectional study

BACKGROUND: Since the initial anecdotal reports of coronavirus disease 2019 (COVID-19) from China, a growing number of studies have reported on smell and/or taste dysfunction (STD). OBJECTIVE: The aim of our study was to investigate the frequency and severity of STD in COVID-19 patients and to evaluate the association with demographic characteristics, hospital admission, symptoms, comorbidities, and blood biomarkers. METHODS: We performed a multicenter cross-sectional study on patients who were positive for SARS-CoV-2 (n=846) and controls (n=143) from 15 Spanish hospitals. Data on STD were collected prospectively using an in-person survey. The severity of STD was categorized using a visual analog scale. We analyzed time to onset, recovery rate, time to recovery, hospital admission, pneumonia, comorbidities, smoking, and symptoms. RESULTS: STD was at least 2-fold more common in COVID-19-positive patients than in controls. COVID-19-positive hospitalized patients were older, with a lower frequency of STD, and recovered earlier than outpatients. Analysis stratified by severity of STD showed that more than half of COVID-19 patients presented severe loss of smell (53.7%) or taste (52.2%); both senses were impaired in >90%. In the multivariate analysis, older age (>60 years), being hospitalized, and increased C-reactive protein were associated with a better sense of smell and/or taste. COVID-19-positive patients reported improvement in smell (45.6%) and taste (46.1%) at the time of the survey; in 90.6% this was within 2 weeks of infection. CONCLUSION: STD is a common symptom in COVID-19 and presents mainly in young and nonhospitalized patients. More studies are needed to evaluate follow-up of chemosensory impairment

INTRODUCCIÓN: Desde los informes anecdóticos iniciales de China sobre la enfermedad por coronavirus 2019 (COVID-19), ha habido un número creciente de estudios que describen disfunción del olfato y/o del gusto (DOG). OBJETIVO: El objetivo fue investigar la frecuencia y la gravedad de la DOG en pacientes con COVID-19 y evaluar su asociación con características demográficas, ingreso hospitalario, síntomas, comorbilidades y biomarcadores sanguíneos. MÉTODOS: Estudio transversal multicéntrico en pacientes con SARS-CoV-2 positivo (n=846) y controles (n=143) de 15 hospitales españoles. Los datos de DOG fueron recopilados de manera prospectiva con una encuesta realizada en persona. La gravedad de la DOG se clasificó por escala visual analógica. Se analizaron el tiempo de aparición de DOG, tasa de recuperación, tiempo de recuperación, ingreso hospitalario, diagnóstico de neumonía, comorbilidades, tabaquismo y síntomas. RESULTADOS: La DOG fue al menos 2 veces más común en pacientes COVID-19 en comparación con los controles. Los pacientes hospitalizados con COVID-19 eran mayores, presentaban una menor frecuencia de DOG y se recuperaron antes que los pacientes ambulatorios. El análisis estratificado por gravedad de la DOG mostró que más de la mitad de los sujetos con COVID-19 presentaron pérdida severa del olfato (53,7%) o del gusto (52,2%), en> 90% este deterioro fue de ambos sentidos. En el análisis multivariante, una edad mayor (>60 años), ser hospitalizado y un mayor nivel de proteína C reactiva fueron factores asociados con un mejor sentido del olfato y/o sabor. Los pacientes positivos para COVID-19 informaron una mejoría del olfato (45,6%) y del gusto (46,1%) en el momento de la encuesta, de ellos, un 90,6% en menos de dos semanas después de la infección. CONCLUSIÓN: DOG es un síntoma común en COVID-19, y principalmente presente en pacientes jóvenes y no hospitalizados. Se necesitan más estudios para evaluar el seguimiento de la discapacidad quimio-sensorial

Endonuclease III and endonuclease IV protect Escherichia coli from the lethal and mutagenic effects of near-UV irradiation.

In contrast to the DNA damage caused by far-UV (lambda < 290 nm), near-UV (290 < lambda < 400 nm) induced DNA damage is partially oxygen dependent, suggesting the involvement of reactive oxygen species. To test the hypothesis that enzymes that protect cells from oxidative DNA damage are also involved in preventing near-UV mediated DNA damage, isogenic strains deficient in one or more of exonuclease III (xthA), endonuclease IV (nfo), and endonuclease III (nth) were exposed to increasing levels of far-UV and near-UV. All strains, with the exception of the nth single mutant, were found to be hypersensitive to the lethal effects of near-UV relative to a wild-type strain. A triple mutant strain (nth nfo xthA) exhibited the greatest sensitivity to near-UV-mediated lethality. The triple mutant was more sensitive than the nfo xthA double mutant to the lethal effects of near-UV, but not far-UV. A forward mutation assay also revealed a significantly increased sensitivity for the triple mutant compared to the nfo xthA deficient strain in the presence of near-UV. However, the triple mutant was no more sensitive to the mutagenic effects of far-UV than a nfo xthA double mutant. These data suggest that exonuclease III, endonuclease IV, and endonuclease III are important in protection against near-UV-induced DNA damage.

Ehrlichia infection in Italy.

Immunoglobulin M seroconversion to Ehrlichia chaffeensis was documented in U.S. citizens bitten by ticks in Sardinia. Seven cases of suspected ehrlichiosis in local residents were not confirmed by laboratory tests. In Alpine areas antibodies to E. phagocytophila were detected in persons at high risk, i.e., foresters (8.6%) and hunters (5.5%), and in controls (1.5%). Of 153 persons bitten by ticks, only one was Ehrlichia antibody-positive after 6 months.

Near ultraviolet radiation (UVA and UVB) causes a formamidopyrimidine glycosylase-dependent increase in G to T transversions.

In contrast to far-UV (< 290 nm) DNA damage, a large fraction of the DNA damage caused by near-UV is oxygen-dependent, suggesting the involvement of reactive oxygen species (ROS). The oxidized base 8-oxo-7,8-dihydroguanine (GO) is characteristic of ROS-induced DNA damage and is removed by Fapy (formamidopyrimidine) glycosylase. We have recently shown that Escherichia coli strains deficient in Fapy glycosylase (fpg) are hypersensitive to the lethal effects of UVA but not far-UV (UVC), suggesting lesions recognized by this enzyme may be important premutagenic or lethal lesions generated by near-UV radiation. In this study, we have found that while the far-UV-induced mutation rates of Fapy-deficient and wild-type strains were similar, near-UV (UVA and UVB) was hypermutagenic to a Fapy-deficient strain, causing a dose-dependent increase in induced mutation relative to wild type (up to five-fold at 200 kJ/m2). Using a plasmid back mutation assay, the predominant near-UV-induced mutations in both wild-type and Fapy-deficient strains were found to be C-->T transitions and G -->T transversions. The former is probably due to replicative bypass of pyrimidine dimers or (6-4) photoproducts that are known to be generated by near-UV, whereas the latter may be due to mispairing of GO lesions with adenine during replication. Consistent with this, the frequency of near-UV-induced G-->T transversions was 16-fold higher in a Fapy-deficient strain than a wild-type strain.

Pulmonary deposition of aerosolised pentamidine using a new nebuliser: efficiency measurements in vitro and in vivo.

The therapeutic efficacy of nebulised pentamidine in the prophylaxis of Pneumocystis carinii pneumonia (PCP) depends on the absolute pulmonary deposition of the drug. We studied the performance of a new nebuliser (Pentasave) by comparison both in vitro and in vivo with a standard nebuliser (Respirgard II). In vitro, deposition of pentamidine labelled with technetium-99m human serum albumin was measured indirectly by capturing inhaled particles on an absolute filter and measuring radioactivity with a gamma camera. The nebulisers were initially assessed with a pentamidine dose of 100 mg in 5 ml at 44 psi and an air flow of 10 l/min for Respirgard II and 16 l/min for Pentasave. Nebuliser output, expressed as the percentage of the initial nebuliser radioactivity captured by the inhalation filter, was 15% +/- 2% (mean +/- SD) for Respirgard II, and significantly increased to 23% +/- 3% for an initial version and to 33% +/- 2% for the final version of Pentasave. Measurements with a gamma camera in a group of ten patients with human immunodeficiency virus infection were made in vivo. The results revealed that pulmonary drug distributions are good using both Respirgard II and Pentasave. The literature reports that once-monthly pulmonary deposition of 9 mg pentamidine seems enough to produce prophylactic effects against Pneumocystis carinii. We measured pulmonary pentamidine deposition of 20.22 +/- 4.31 mg (mean +/- SD) using Respirgard II (with 300 mg in 5 ml) and of 16.00 +/- 7.18 mg using Pentasave (with 150 mg in 6 ml). These findings show that the therapeutic dose of pentamidine (9 mg) was widely exceeded with both nebulisers. Further investigations might demonstrate that about 200 mg and 125 mg pentamidine for Respirgard II and Pentasave, respectively, will achieve a pulmonary deposition of therapeutic dose, allowing significant savings in terms of drug and expense.

[Complications of hepatic hydatidosis]. / Complicanze dell'idatidosi epatica.

Fifty cases of complicated hydatid cyst of the liver on a total of 250 cases of hydatid cyst observed were analyzed. The Authors describe the several complications observed (compression, infection, rupture into biliary tract or into the thorax or into the peritoneal cavity, the diagnostic and therapeutic procedures. Total mortality was about 7.6% (3 cases) 2 patient died for intraperitoneal rupture and one for rupture in the biliary tract. Surgical treatment should be as radical as possible performing total or subtotal pericystectomy, hepatic resection is reserved to selected cases. Drainage by Kehr tube of biliary tract is necessary of rupture of the cyst in the biliary tract, while we limit the indication for a papillostomy to the sphincter duct stenosis.

[Tracheostomy: indications, techniques, and complications]. / La tracheostomia: indicazioni, tecnica e complicanze.

The authors report their experience relative to 46 tracheostomies performed over a 10-year period. In 6 cases the indication for a tracheostomy was a post-traumatic respiratory failure; in 20 cases a chronic respiratory insufficiency, in 6 cases a malignant neoplasm of the larynx; in 10 cases a postoperative respiratory insufficiency; in 4 cases for tongue and/or neck wounds. The authors stress the importance of a correct indication, the use of large volume-low pressure cuffs and an appropriate surgical technique to prevent complication of tracheostomy.

[Hydatid choleperitoneum: a rare complication of hepatic hydatid disease]. / Idatidocoleperitoneo: rara complicanza della idatidosi epatica.

The authors report their experience relative to hydatid choleperitoneum which is a rare complication of hydatid hepatic disease (one case of 236 operated). They underline how such pathology constitutes a clinic and anatomopathological case, well characterized and different from those offered by other complications of this hepatic disease. They draw attention moreover on how preoperative diagnosis is often difficult and consequently how the surgical therapeutic technique requires a very careful examination of anatomic relations of the lesion and recognize, as a chiefly foundation, a radical treatment of hepatic disease and whenever possible, the removal of the pseudomembrane of encystment.

[Detection of thrombosis of the left atrium in mitral valve stenosis. Particular value of transesophageal echography]. / Détection des thromboses de l'oreillette gauche du rétrécissement mitral. Intérêt particulier de l'échographie transoesophagienne.

This retrospective study assessed the prevalence of left atrial thrombi in mitral stenosis and evaluated the diagnostic value ot the main means of investigation Five hundred and eighty-one patients underwent open heart surgery over a 10 year period. The prevalence of atrial thrombi was 7%, the majority (60%) being located in the left atrial appendage. The sensitivity of transthoracic echocardiography for detecting thrombi in the left atrial cavity was satisfactory (65%) but was very poor for detecting thrombi in the left atrial appendage (4%). The results of invasive investigations (atrial angiography and coronary angiography) are no better. Without any doubt, transoesophageal echocardiography, performed in 101 patients in this series, has transformed these results (sensitivity 83%, specificity 97%). False negatives in this study mainly concerned small thrombi adherent to the atrial wall. Under these conditions, it would seem reasonable to propose transoesophageal echocardiography to all patients with mitral stenosis complicated by an embolic event or for those for whom percutaneous commissurotomy is suggested.

[Perforation of the colon]. / Le perforazioni del colon.

The paper reports personal observations relating to 111 cases of colonic perforation. Etiopathogenesis and different surgical approaches are discussed and results are compared. Hartmann's operation is identified as the best solution in cases of colonic perforation with diffuse peritonitis. In cases of localized peritonitis, excellent results may be obtained by operating immediately.

Three-dimensional display of myocardial perfusion: detection of ischemic lesions using a new image subtraction method.

A recent, commercially available computer program for the three-dimensional (3D) display of single-photon emission tomography (SPET) data was used to study myocardial perfusion in patients with coronary artery disease (CAD). To enable the detection of small ischemic lesions, the authors proposed a new "distance-substraction" method: after suitable centering of the axial slices, 3D "distance-shaded" images of the stress study were subtracted from the corresponding views of the rest study. With this technique, small changes in surface-to-observer distance were highlighted, thus enabling us to detect nontransmural ischemic areas of the myocardium. General characteristics and possibilities of the subtraction technique were tested on a simple myocardial phantom. Some clinical results of the application of this method on CAD patients are presented and discussed. In CAD patients in whom only nontransmural ischemic lesions are present, the subtraction of "distance-shaded" images is decisive for a correct diagnosis.

[Emergency surgery in icterus]. / Chirurgia d'urgenza negli itteri.

Obstructive jaundice may be, still today, a surgical emergency. After the analysis of the serious syndrome following a persistent cholestasis, the authors discuss new technological diagnostic procedures and indications, pros and cons of the use of P.T.D. (Percutaneous Transhepatic Drainage). Finally, they underline emergency cases and proper surgical management, on the basis of their personal experience, as well.

[Myocardial perfusion visualized with SPECT: three-dimensional representation]. / Perfusione del miocardio con SPECT: rappresentazione tridimensionale.

A recently developed computer program for three-dimensional (3D) reconstruction of SPECT images has been employed to study myocardial perfusion in coronaropathic patients using MIBI-99mTc or 201Tl chloride. By subtracting after-stress from at-rest 3D reconstructed images, even small ischemic lesions could be located in the myocardium, with good morphological definition. The general characteristics of the method and some clinical results are here presented.

Theophylline pharmacokinetics in patients with bronchopulmonary dysplasia.

Theophylline is commonly used to decrease airway resistance in patients with bronchopulmonary dysplasia (BPD). Little is known, however, about theophylline's pharmacokinetics in infants' with BPD. The objectives of this study were: (i) to examine the pharmacokinetics of theophylline; and (ii) to assess the intrapatient variation in theophylline serum concentration in BPD. Nineteen patients (gestational age: 27-33 weeks, postnatal age: 12-165 days) received 2-12 mg/kg/day theophylline. Multiple serum concentrations of theophylline were determined in each patient. Apparent clearance of theophylline ranged from 0.28 to 0.51 ml/min/kg. The steady-state trough serum concentration of theophylline ranged from 3.5 to 11.2 micrograms/ml. Based on our data, theophylline doses of 4-7 mg/kg/day may be required to achieve an average steady-state serum concentration of 10 micrograms/ml. Substantial intrapatient (twofold) variability was observed in theophylline concentrations normalized for dose during therapy. The data indicate that the theophylline serum concentration should be monitored for individualizing therapy in infants with BPD.

Management of liver trauma.

A ten-year experience with the management of liver trauma is reported. The diagnostic approach is examined, stressing the role of selective arteriography. The management of the 78 observed cases is described. The need for biliary drainage to prevent postoperative leakages, is supported. Overall mortality in this series was 16.6%.