Anosmia Research Articles

Exploratory Research: Patient-Reported Factors Contributing to Decreased Oral Intake During Radiotherapy in Head and Neck Cancer.

Radiotherapy (RT) in head and neck cancer (HNC) can cause multiple side effects such as nausea, pain, taste loss, fatigue, oral mucositis, xerostomia, and acute radiation-associated dysphagia (RAD). These factors threaten patients' oral intake (OI) during this RT. Reduced OI can cause weight loss, dehydration, malnutrition, and various comorbidities. On top, reduced OI significantly affects quality of life and may contribute to RAD through the disuse of swallowing muscles. With the aim of maximizing the retention of a patient's OI, it is important to gain an insight into the factors that have the greatest impact. Therefore, this study aims to identify the impact of contributing factors on decreased OI during RT. During their treatment, 55 HNC patients completed an OI questionnaire at 5 different time points: during weeks 1, 2, 3, and 4 and at the end of RT (week 7). First, patients rated the OI compared to pre-RT on a 100 mm visual analogue scale (VAS). Subsequently, patients reported on separate VAS the degree to which pain, fatigue, loss of taste, loss of smell, loss of interest in food, nausea, and loss of hunger contributed to the decrease in OI (0: no contribution; 100: complete contribution). SPSS version 27 was used to analyze the results. OI decreased over time during RT, with the lowest OI at the end of RT. During the first 4 weeks of RT, the impact of all factors with pain, loss of taste, loss of interest in food, and loss of hunger pointed out as strongest contributing factors to a decreased OI. The most important patient-reported impacting factor on OI was loss of taste. At the end of RT, the importance of pain and nausea still increases, while the contribution of the other factors drops slightly. This cohort study shows that several factors contribute to a decreased OI in HNC patients during RT. This study is the first prospective analysis to identify self-reported factors contributing to reduced OI. Results demonstrate that taste has the greatest impact on OI followed by loss of interest in food, loss of hunger, and pain.

Neurochemical Alterations Linked to Persistent COVID-19-Induced Anosmia: Probing Into Orbitofrontal Cortex by Magnetic Resonance Spectroscopy.

While many COVID-19-induced anosmia patients recover their sense of smell within a few months, a substantial number of them continue to experience olfactory impairment. In our primary study, the metabolic patterns in orbitofrontal cortex (OFC) were observed to exhibit more alterations than other regions. Hence, this study specifically probes into alterations within OFC region in subjects with persistent COVID-19-induced anosmia. In a new categorization, 54 subjects were studied as two major groups of COVID-19-related anosmia and normal each of which includes 27 subjects. Iran Recognition-Smell Identification Test (IR-SIT) over a three-month follow-up period was utilized for olfactory function assessment and anosmia diagnosis. Proton Magnetic Resonance Spectroscopy (1H-MRS) was employed to examine changes of metabolites in OFC, including N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr), as well as their ratios. Additionally, a linear regression was applied to investigate the potential correlation between MRS data and IR-SIT scores. Patients with COVID-19-induced anosmia exhibited a significant reduction in NAA, Cho, and Cr levels in the OFC region compared to the control group. Moreover, NAA/Cho and NAA/Cr ratios were lower in the anosmia patients, whereas the Cho/Cr ratio elevated. The NAA/Cho ratio had the highest linear correlation with IR-SIT scores in anosmia. This study highlights remarkable neurochemical patterns associated with COVID-19-induced anosmia in brain orbitofrontal cortex detectable by proton MRS, shedding light on the link between OFC function impairment and anosmia. The NAA/Cho ratio derived from MRS data emerged as a potential biomarker that correlates with anosmia severity and recovery examination.

Dysregulation of Metabolic Peptides Precedes Hyperinsulinemia and Inflammation Following Exposure to Rotenone in Rats.

Rotenone, a naturally occurring compound derived from the roots of tropical plants, is used as a broad-spectrum insecticide, piscicide, and pesticide. It is a classical, high-affinity mitochondrial complex I inhibitor that causes not only oxidative stress, α-synuclein phosphorylation, DJ-1 (Parkinson's disease protein 7) modifications, and inhibition of the ubiquitin-proteasome system but it is also widely considered an environmental contributor to Parkinson's disease (PD). While prodromal symptoms, such as loss of smell, constipation, sleep disorder, anxiety/depression, and the loss of dopaminergic neurons in the substantia nigra of rotenone-treated animals, have been reported, alterations of metabolic hormones and hyperinsulinemia remain largely unknown and need to be investigated. Whether rotenone and its effect on metabolic peptides could be utilized as a biomarker for its toxic metabolic effects, which can cause long-term detrimental effects and ultimately lead to obesity, hyperinsulinemia, inflammation, and possibly gut-brain axis dysfunction, remains unclear. Here, we show that rotenone disrupts metabolic homeostasis, altering hormonal peptides and promoting infiltration of inflammatory T cells. Specifically, our results indicate a significant decrease in glucagon-like peptide-1 (GLP-1), C-peptide, and amylin. Interestingly, levels of several hormonal peptides related to hyperinsulinemia, such as insulin, leptin, pancreatic peptide (PP), peptide YY (PYY), and gastric inhibitory polypeptide (GIP), were significantly upregulated. Administration of rotenone to rats also increased body weight and activated macrophages and inflammatory T cells. These data strongly suggest that rotenone disrupts metabolic homeostasis, leading to obesity and hyperinsulinemia. The potential implications of these findings are vast, given that monitoring these markers in the blood could not only provide a crucial tool for assessing the extent of exposure and its relevance to obesity and inflammation but could also open new avenues for future research and potential therapeutic strategies.

Intranasal Calcitriol Accelerates Improvement of Sinonasal Inflammation and Olfactory Impairment in Mice After Cessation of Chronic Cigarette-Smoke Exposure.

Smoking has been shown to be associated with circulating deficiencies in 25(OH)D3 and reduced sinonasal tissue levels of the active form of vitamin D, 1,25(OH)2D3. Given vitamin D's ability to reduce inflammation, we sought to examine if intranasal (IN) delivery of calcitriol [clinical analog of 1,25(OH)2D3] could reduce inflammation and improve disease severity in a murine model of chronic cigarette smoke-induced sinonasal inflammation (CS-SI). Mice were exposed to CS 5 h/day, 5 days/week for 9 months, and then began IN calcitriol three times per week for 4 weeks. Micro-CT was used to assess disease severity. Sinonasal tissues were collected for RNA-seq analysis. Olfactory function was assessed using a T-maze odorant avoidance sniff behavior test. Nasal lavage fluid (NALF) was used for cytology and cytokines analysis. Quantification of disease severity by micro-CT showed IN calcitriol reduced opacification by 18%, as compared to smoke cessation alone, in which only a 5% reduction was noted. H&E analysis of NAFL demonstrated heightened neutrophil infiltration and neutrophil-associated chemokines in CS-SI mice, which was reduced with IN calcitriol treatment. RNA-seq pathway analysis demonstrated that smoking was associated with odorant binding changes and that calcitriol treatment reduced neutrophil migration and inflammation. Lastly, IN calcitriol reversed olfactory loss caused in CS-SI. IN delivery of calcitriol accelerates inflammatory resolution in the nose and olfactory mucosa after prolonged CS exposure. Furthermore, treatment was associated with improved olfactory function in mice CS-SI, as such local delivery of calcitriol may serve as a novel treatment for modulating sinonasal inflammation.

Olfactory Impairment and Recovery in Zebrafish (Danio rerio) Following Cadmium Exposure.

Anthropic activities have significantly elevated cadmium levels, making it a significant stressor in aquatic ecosystems. Present in high concentrations across water bodies, cadmium is known to bioaccumulate and biomagnify throughout the food chain. While the toxic effects of cadmium on the organs and tissues of aquatic species are well-documented, little is known about its impact on sensory systems crucial for survival. Consequently, this study investigated the impact of short-term exposure (96 h) to 25 µM cadmium chloride on the olfactory system of adult zebrafish. The research aimed to assess structural and functional changes in the zebrafish's olfactory lamellae, providing a deeper understanding of how cadmium affects the sense of smell in this aquatic species. After exposure, cyto-anatomical alterations in the lamellae were analysed using light microscopy and immunocytochemistry. They revealed severe lamellar edema, epithelial thickening, and an increased number of apoptotic and crypt cells. Rodlet and goblet cells also increased by 3.5- and 2.5-fold, respectively, compared to control lamellae, and collagen density in the lamina propria increased 1.7-fold. Cadmium upregulated metallothioneins and increased the number of PCNA-positive cells. The olfactory function was assessed through a behavioural odour recognition test, followed by a recovery phase in which zebrafish exposed to cadmium were placed in clean water for six days. The exposed fish performed poorly, failing to reach food in five consecutive trials. However, lamellar damage was reduced after the recovery period, and their performance improved, becoming comparable to the control group. These results suggest that cadmium disrupts the sense of smell, and that recovery is possible after short-term exposure. This evidence sheds light on aspects of animal survival that are often overlooked when assessing environmental pollution.

Adverse health outcomes and health-related quality of life (HRQoL) among long-term adolescent and young adult (AYA) brain tumour survivors: results from the population-based SURVAYA study

PurposeAdolescent and young adult (AYA) malignant brain tumour (BT) survivors are at risk of adverse health outcomes, which may impact their health-related quality of life (HRQoL). This study aimed to investigate the (1) prevalence of physical and psychological adverse health outcomes, (2) the HRQoL, and (3) the association of adverse health outcomes and HRQoL among long-term AYA-BT survivors. Adverse health outcomes and HRQoL were compared to other AYA cancer (AYAC) survivors.MethodsA cross-sectional secondary data analysis of the SURVAYA study among 133 AYA-BT and 3877 AYAC survivors was conducted. Participant self-reported adverse health outcomes and HRQoL scores were analysed and compared between the two populations. Associations with HRQoL were assessed using linear regression modelling with AIC-based backward elimination.ResultsAYA-BT survivors faced significant issues of fatigue (47.6%), future uncertainty (45.2%), and medical conditions like vision (34.4%), speech, taste, or smell (26.2%) impairments, cancer recurrence, and metastasis (25.4%). Neurocognitive symptoms were identified as BT-specific issues (13.6–33.6%). Compared to AYAC survivors, AYA-BT survivors reported significantly (p < 0.05) lower functioning scores on the role, cognitive, emotional, and social HRQoL, with cognitive (56.0%) and emotional (40.0%) domains being the most affected. Adverse health outcomes were negatively associated with HRQoL, ranging from small to large clinical relevance.ConclusionLong-term AYA-BT survivors were identified as a highly burdened population, affected by multifaceted issues and multidimensional detriments in HRQoL years beyond their cancer diagnosis. This study highlights the necessity of long-term follow-up and a holistic, multidisciplinary approach to survivorship care to ultimately improve the quality of AYA-BT survivorship.

Demographic and Clinical Characteristics of Sino-Nasal Tumour Patients: A Cross-Sectional Study of 60 Cases

Introduction: Sino-nasal tumors are a rare yet clinically significant group of neoplasms that affect the nasal cavity and paranasal sinuses. Although these tumors represent a small percentage of head and neck cancers, they often present with complex symptoms and can be challenging to diagnose early. This study aimed to evaluate the demographic and clinical characteristics of sino-nasal tumor patients. Methods: This cross-sectional observational study was conducted at the ENT and Head-Neck Surgery department, Rajshahi Medical College Hospital, Rajshahi, from June 2014 to November 2014. A total of 60 patients presenting with sinonasal tumors were selected as study subjects by purposive sampling technique. Data analysis was done by Statistical Package for Social Sciences (SPSS) version 20.0. A descriptive method was adopted. Result: In this study of 60 sino-nasal tumor patients, the age groups 21-30 and 51-60 years had the highest representation (20% each), with the majority being male (76.67%) and primarily woodworkers (40%). Socioeconomically, 75% of patients were classified as "poor." Smoking was the most prevalent habit, affecting 50% of patients. Clinically, nasal obstruction was the most common symptom (93.33%), followed by loss of smell (70%) and epistaxis and headache (50% each). The majority of tumors were benign (93.33%), with only 6.67% being malignant. Among malignancy cases, nasal obstruction was a universal symptom, with facial pain, headache, and hyposmia observed in 75% of these patients. Conclusion: This study concludes that sino-nasal tumors predominantly affect middle-aged men, often with significant occupational exposure to carcinogenic materials like wood dust and industrial chemicals. Socioeconomic and lifestyle factors further compound the risk, highlighting the importance of comprehensive preventive measures and early detection strategies, particularly in high-risk occupations. Awareness of prevalent symptoms such as nasal obstruction, ...

Olfactory impairment in Italian patients with chronic rhinosinusitis with nasal polyps: a patient-centered survey.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition characterized by persistent nasal obstruction, discharge, facial pressure, and olfactory dysfunction. CRSwNP significantly impairs quality of life (QoL), with olfactory loss being a particularly distressing symptom that affects food enjoyment, personal safety, and social interactions. This study investigated the experiences of Italian patients with CRSwNP. A cross-sectional quantitative and qualitative survey (Google Forms questionnaire), collecting data on diagnosis, symptomatology, QoL impact, and treatment experiences was developed and distributed. There were 155 respondents, with over half diagnosed with CRSwNP for more than a decade. Nasal obstruction was the primary symptom leading to medical consultation. Corticosteroid therapy and surgery showed limited and variable effectiveness in olfactory restoration. Biologic therapy, particularly dupilumab, demonstrated promising results, with approximately half of the patients reporting complete smell restoration. CRSwNP significantly affected patients' QoL, with olfactory dysfunction being a common and impactful symptom. While current treatments provide symptom relief, they do not always result in sustained olfactory improvement. Biologic therapy emerged as a promising option for olfactory restoration, underscoring the importance of personalized treatment strategies. Further research is warranted to explore the mechanisms of olfactory recovery and to optimize treatment protocols for CRSwNP.

Analysis of factors influencing quality of life in patients with olfaction disorders

Objective: To explore the differences in quality of life among patients with olfaction disorders (OD) due to various etiologies and to identify factors influencing olfactory-related quality of life. Methods: This cross-sectional study enrolled patients with OD who visited the Department of Otolaryngology at Fudan University Eye, Ear, Nose, and Throat Hospital between February and June 2024. Psychophysical olfactory test was performed using the Chinese Smell Identification Test (CSIT), which was based on the Chinese population, with the TDI score used as the total score for threshold (T), discrimination (D), and identification (I) tests. The quality of life related to OD was assessed using a brief version of the Questionnaire of Olfactory Disorders (bQOD), which included QOD-P, QOD-Q, and QOD-VAS. Visual analog scales (VAS) was used to rate the degree of subjective decline in olfaction. Statistical analysis was conducted to assess the impact of etiologies, age, gender, onset time, psychophysical olfactory tests, and subjective assessment on olfactory-related quality of life. Results: A total of 419 patients were enrolled, including 220 males and 199 females, with the age of (39.72±14.31) years (range: 5 to 76 years). Among the 419 patients, 380 completed the bQOD and VAS assessment. The results showed that there were intergroup differences in the QOD-P and QOD-Q scores among patients with OD caused by different etiologies (P values were 0.001 and 0.003, respectively). The QOD-P score was negatively correlated with age (P<0.05), and positively correlated with the TDI score (P<0.01). The QOD-Q score was negatively correlated with disease duration (P<0.05), and positively correlated with the patients' subjective olfactory decline as assessed by the VAS score (P<0.01), and had no significant correlation with psychophysical olfactory tests. Female patients had lower QOD-Q scores than male patients (P<0.05). The QOD-VAS score was positively correlated with the patients' subjective olfactory impairment (P<0.01) and showed no significant correlation with psychophysical olfactory tests. Female patients had worse QOD-VAS scores than male patients (P<0.05). Conclusion: Compared with psychophysical olfactory tests, VAS olfactory scores are more closely related to quality of life. Different etiologies, duration of the disease, and gender also affect olfactory-related quality of life.

SOCIO-EPIDEMIOLOGICAL PROFILE AND EFFECTS OF LONG-COVID-19 ON POST-PANDEMIC PATIENTS FROM SOUTHERN BRAZIL

COVID-19 has been the biggest public health problem worldwide. Several people were infected by the SARS-CoV-2 virus, developing or not the related symptoms. Among the COVID-19 symptoms, many subjects had fever, cough, muscle pain, headache, loss of taste, loss of smell, among others, while some individuals presented more complex symptoms, such as severe acute respiratory syndrome. Still today there is no specific treatment against COVID-19. Although many pharmacological protocols were tried, including for example antibiotics and anti-inflammatories. Most of the infected subjects recovered from the disease, however, several patients still have some persistent symptoms, characterizing the so-called long-COVID-19. The objective of this study was to identify socio-epidemiological profile and effects of long-COVID-19 on post-pandemic patients. For this, a questionnaire of self-report was applied for 74 patients who recovered from COVID-19. This instrument of data collection included questions regarding socioeconomic aspects, symptoms during the disease, previous health history, use of medication before, during and after COVID-19, vaccination, use of legal and illegal drugs, physical activities, and sequelae and persistent symptoms. It was found that most of the volunteers were female and were about 31-50 years old. Also, most of the patients did not use the hospitalization services. Several patients self-reported the presence of some comorbidities prior to the infection, such as metabolic diseases. The majority had mild symptoms, such as headache and dysgeusia. Interestingly, 69% of the participants reported presenting persistent symptoms after recovering from COVID-19, mainly memory loss, hair loss and fatigue. About 13% reported symptoms related to cognitive impairments. This study shows the importance of continuing the scientific investigations in the present, especially considering the long-COVID-19 for the public health agencies and governments to be able to plan potential actions for the affected patients.

Cognitive deficits and cortical volume loss in COVID-19-related hyposmia.

Studies have found that up to 73% of COVID-19 patients experience hyposmia. It is unclear if the loss of smell in COVID-19 is due to damage to the peripheral or central mechanisms. This study aimed to explore the impacts of COVID-19-induced hyposmia on brain structure and cognitive functions. The study included 36 hyposmic (h-COV) and 21 normosmic (n-COV) participants who had recovered from mild COVID-19 infection, as well as 25 healthy controls (HCs). All participants underwent neurological examination, neuropsychiatric assessment and Sniffin' Sticks tests. High-resolution anatomical images were collected; olfactory bulb (OB) volume and cortical thickness were measured. Addenbrooke's Cognitive Examination-Revised total and language sub-scores were slightly but significantly lower in the h-COV group compared to the HC group (p = 0.04 and p = 0.037). The h-COV group exhibited poorer performance in the Sniffin' Sticks test terms of discrimination score, identification score and the composite score compared to the n-COV and HC groups (p < 0.001, p = 0.001 and p = 0.002 respectively). A decrease in left and right OB volumes was observed in the h-COV group compared to the n-COV and HC groups (p = 0.003 and p = 0.006 respectively). The cortical thickness analysis revealed atrophy in the left lateral orbitofrontal cortex in the h-COV group compared to HCs. A significant low positive correlation of varying degrees was detected between discrimination and identification scores and both OB and left orbital sulci. Temporary or permanent hyposmia after COVID-19 infection leads to atrophy in the OB and olfactory-related cortical structures and subtle cognitive problems in the long term.

Aspectos de saúde geral, mental e auditiva de trabalhadores da equipe de enfermagem de um hospital público acometidos pela Covid-19

ABSTRACT Purpose: to analyze possible impacts on the general, mental and hearing health of nursing workers affected by the COVID-19 virus. Methods: an exploratory, cross-sectional study, carried out with nursing professionals from a public hospital in Southern Brazil, who answered a questionnaire on general and auditory symptoms after COVID-19 infection, and the Oldenburg Burnout Inventory (OLBI). Statistical analysis was performed using the Chi-square test of independence, the ANOVA test with Tukey's post-test and Pearson's Linear Correlation, with a p-value of 5%. Results: 52 workers participated (17 nurses, 30 technicians, five aides). The symptoms of headache, loss of smell and taste, fatigue and muscle pain were reported by more than 75% of workers; 80.8% either had already been classified as burnout (40.4%) or featured high scores for exhaustion or work disengagement (40.4%), with a correlation with the symptoms of cough (p=0.0327) and fever (p=0.0235); 44.23% had auditory symptoms, with dizziness/vertigo reported by 34.6% and tinnitus by 13.5%, although without correlation with burnout levels (p=0.4250). Conclusion: there were impacts on the general, mental and hearing health of nursing workers who were diagnosed with COVID-19, mainly cough and fever, burnout, tinnitus and dizziness.

What is causing this patient's loss of smell?

What is causing this patient's loss of smell?

Biologic Treatments for Chronic Rhinosinusitis With Nasal Polyps (CRSwNP): A Comparative Review of Efficiency and Risks.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition of the nasal passages and sinuses, often characterized by nasal congestion, loss of smell, facial pressure, and nasal discharge. Conventional treatments, such as corticosteroids and endoscopic sinus surgery (ESS), often provide only temporary relief, with frequent recurrence of symptoms. For patients with severe, refractory CRSwNP, biologic therapies have emerged as a promising treatment option. This review evaluates the efficacy and safety of biologictreatments for CRSwNP, including dupilumab, mepolizumab, and omalizumab. We analyze clinical trial data, patient-reported outcomes, and the latest research on the use of biologics in CRSwNP management. Our findings confirm the efficacy of biologics in treating CRSwNP, showing consistent improvements in both clinical and patient-reported outcomes. The use of biologics resulted in a significant reduction in nasal polyp size, improved nasal congestion, and reduced the need for further surgery or systemic corticosteroids. Moreover, patients experienced an improved sense of smell and a better quality of life. This review also includes a comparative analysis of the three biologics, highlighting their efficiency and potential risks.The findings suggest that dupilumab may be the most effective biologic therapy for CRSwNP, showing superior efficacy compared to mepolizumab and omalizumab in reducing nasal polyp size and improving nasal congestion. The article provides valuable insights for healthcare providers and patients considering biologic therapy for CRSwNP, emphasizing the importance of personalized treatment decisions based on individual patient factors, including disease severity, comorbidities, and preferences.

Refinement of post-COVID condition core symptoms, subtypes, determinants, and health impacts: A cohort study integrating real-world data and patient-reported outcomes

Post-COVID-19 condition (PCC) affects millions of people, and is an essential component of the long-term impact of COVID-19 during the post-pandemic era. Yet, consensus on clinical case definition and core components of PCC remains lacking, affecting our ability to inform research and evidence-based management. Our study aims 1) to identify the most specific symptoms for PCC, and identify clinical subtypes; 2) to evaluate both virus- and host-related determinants of PCC, and 3) assess the impact of PCC on physical and mental health. We studied participants from UK Biobank who completed a health and wellbeing survey between June and September 2022. Participants reported the current conditions of the presence, duration, and functional limitations of 45 symptoms, using an online questionnaire designed specifically for COVID-19 research. SARS-CoV-2 infection status and disease history were obtained through linkage to surveillance data and electronic medical records, respectively. Participants reporting symptoms within 30 days after infection (acute phase) were excluded. The most specific PCC symptoms were defined using two criteria: statistical significance (P<0.05 after Bonferroni correction) and clinical relevance (absolute risk increase > 5%). Propensity score weighting was used to control for confounding. Subtypes of PCC were then defined based on the specific symptoms among the COVID-19 infected individuals. A multivariable regression was used to study pathogen- and host-related risk factors for PCC, and its impact on 13 physical and 4 mental health patient-reported functional outcomes. 172,303 participants (mean age 68.9, 57.4% female) were included in the analysis, of whom 43,395 had PCR-confirmed COVID-19. We identified 10 most specific symptoms and classified four PCC subtypes: ENT subtype (30.1%), characterized by alterations in smell, taste, and hearing loss; cardiopulmonary subtype (10.4%), characterized by shortness of breath, postural tachycardia, chest tightness, and chest pressure; neurological subtype (23.5%), characterized by brain fog and difficulty speaking; and general fatigue subtype (38.0%), characterized by mild fatigue. A higher PCC risk was observed for patients with Wild-type variant, multiple infections, and severe acute COVID-19 illness, consistently across the four PCC subtypes. In addition, a range of factors, including socioeconomic deprivation, higher BMI, unhealthy lifestyle, and multiple chronic health conditions, were associated with increased PCC risk, except for age and sex. Conversely, vaccination was associated with a largely reduced PCC risk, particularly for the cardiopulmonary subtypes. Individuals with PCC experienced a much worse physical and mental health. Specifically, the cardiopulmonary subtype had the most pronounced adverse impact on function impairments, followed by neurological, mild fatigue, and ENT subtype. The most affected functions included the ability to concentrate, participate in day-to-day work, and emotional vulnerability to health problems. PCC can be categorized into four distinct subtypes based on ten core symptoms. These subtypes appeared to share a majority of pathogen and host-related risk factors, but their impact on health varied markedly by subtype. Our findings could help refine current guidelines for precise PCC diagnosis and progression, enhance the identification of PCC subgroups for targeted research, and inform evidence-based policy making to tackle this new and debilitating condition. NIHR Senior Research Fellowship (grant SRF-2018-11-ST2-004).

Olfactory dysfunction in schizophrenia and other psychotic disorders: A comprehensive and updated meta-analysis.

Olfaction plays a key role in our daily life, influencing food enjoyment, threat detection, mood and social relationships. Numerous studies have provided evidence of abnormal olfactory function in schizophrenia and other psychotic disorders. This pre-registered meta-analysis was conducted to (a) provide an updated overview of olfactory function in schizophrenia-spectrum disorders, and (b) examine the modulatory effects of demographic and clinical variables on distinct olfactory abilities. We complied with the PRISMA guidelines, searching throughout PubMed, MEDLINE, and PsycInfo, until the 12th of August 2023. A total of 73 publications were included, comprising data from 3282 patients and 3321 healthy controls. Results revealed that (a) patients performed significantly worse in higher-order olfactory tests (identification and discrimination) compared to healthy controls, while no differences were observed in odor sensitivity; (b) patients' performance in odor identification was moderated by education, as well as disease duration and negative symptoms. Our findings support the presence of olfactory impairments in schizophrenia-spectrum disorders, leading to significantly poorer performance in both odor identification and discrimination, but not sensitivity, when compared to healthy controls.

DISINTEGRATION OF THE SELF SYSTEM IN A PATIENT WITH SEMANTIC VARIANT PPA (SVPPA) DIAGNOSED FOLLOWING SARS-COV-2 INFECTION AND COVID-19

The aim of this study is to present a patient with semantic variant PPA (svPPA) diagnosed following SARS-CoV-2 infection and COVID-19 contraction, who experienced a dramatic disintegration of the Self system.The patient, a 45-year-old bilingual physician with no chronic diseases, contracted SARS-CoV-2 in November 2020, confirmed by RT-PCR. During acute COVID-19, he developed high fever (40C) and neurological symptoms such as severe headache, dizziness, confusion, and loss of smell. About 16 weeks later, he had difficulties understanding common words in Polish and English (he was bilingual). One year post-COVID-19, his language impairment has intensified affecting word comprehension and naming. His syntax and phonology in Polish remained relatively intact, but he appeared confused. Despite losing word meaning, he could still use various objects. Psychiatric examination showed no mental illness, while neurological and neuropsychological assessments revealed long COVID with predominant aphasia symptoms. He had problems with lexical classification and higher-level differentiation. A MRI one year after COVID-19 showed significant asymmetric cortical atrophy in the temporal regions, predominantly on the left side, and in subcortical areas. In the Polish Boston Naming Test (BNT), he had difficulty recalling well-known items and used general descriptions instead (the patient occasionally mixed Polish and English). In the Pyramids and Palm Trees Test (PPTT) we found impairment of semantic memory. Surface dyslexia and dysgraphia were also found. Working memory impairment increased as the disease progressed. Information flow was profoundly disturbed, and ERPs to all stimuli significantly reduced. Two years after contracting COVID-19, the patient exhibited significant loss of object knowledge and constructional apraxia. He developed blank speech, making incoherent statements. As the disease progressed the patient lost his sense of identity, unable to recognize objects or faces, including his reflection. In June 2023, just over two and a half years after contracting COVID-19, the patient developed pneumonia. He was hospitalized and died a few days later. Post-mortem examinations revealed asymmetric cortical atrophy of the temporal lobes, more severe in the left hemisphere, which is associated with language functions. TDP-43 proteinopathy was also diagnosed. We will discuss the multifaceted symptoms and significance of this case study for modern medicine.This reliably documented case serves as a significant contribution to modern neuroscience, offering valuable insights into the intersection of COVID-19 and neurodegenerative diseases, and paving the way for future research and improved patient care.

Long‐term Outcomes of PRP Injections for Post‐viral Olfactory Loss: A Prospective Cohort Study

ABSTRACTBackgroundPlatelet‐rich plasma (PRP) injections have previously been shown to benefit coronavirus disease 2019 (COVID‐19)‐induced smell loss. It is unknown if that benefit is stable over time. The aim of this study was to assess outcomes at 1‐year post‐intervention.MethodsProspective cohort study. Sixteen patients (10 PRP and six placebo) from the original PRP randomized placebo‐controlled clinical trial, and a further 16 patients from smell clinic who were a year out from initial treatment (six PRP patients and 10 non‐PRP) were enrolled. University of Pennsylvania Smell Identification Tests (UPSITs) and visual analog scale (VAS) subjective scores were compared to initial scores.ResultsThere was no difference between groups with respect to age, gender, race, duration of smell loss prior to intervention, smoking or diabetes status, Charlson comorbidity index, presence of phantosmia or parosmia, or baseline UPSIT score. The PRP group had a significantly higher change in UPSIT score at 1 year (p = 0.001), a higher number of patients who met the minimal clinically important difference for the UPSIT (87.5% vs. 31.2%, p = 0.004), and a significantly greater change in VAS at 1 year (p = 0.001), compared to those who did not receive injections. On multivariate logistic regression analysis, no factors appeared to have a significant effect on these findings.ConclusionPRP injections into the olfactory cleft now have long‐term data suggesting benefit in both subjective and psychophysical measures of smell, and improvements in both realms at 1 year are significantly higher than in those who do not receive the injections.

COVID-19 and liver

Abstract Background and aims The coronavirus disease 2019 (COVID-19) presents a significant health risk, affecting both healthy individuals and those with underlying health conditions, including liver diseases. This study aimed to evaluate the impact of COVID-19 on liver function in both hepatic and non-hepatic patients across varying degrees of disease severity, as confirmed by PCR testing. Methods In this prospective study, we included patients with confirmed COVID-19, both with and without liver conditions, who were admitted to the National Hepatology and Tropical Medicine Research Institute (NHTMRI) and Embaba Fever Hospital between November 2020 and July 2021. Results The study cohort consisted of 255 confirmed COVID-19 patients (mean age 52.16 years, 48.6% male, 24.3% with liver conditions). Among those with liver disease, 6.4% had mild symptoms, while 4.8%, 56.4%, and 33.8% experienced moderate, severe, and critical symptoms, respectively. Clinical characteristics were insignificantly different between hepatic and non-hepatic patients across the various COVID-19 severity grades, with the exception of the loss of taste and smell in severe cases and hepatic encephalopathy and oxygen saturation in critical cases. Laboratory findings similarly showed no significant differences, except that hepatic patients exhibited a notable decrease in platelet count and a significant increase in AST and bilirubin levels compared to non-hepatic patients. In critical COVID-19 cases, non-hepatic patients had significantly higher serum ferritin levels, while hepatic patients demonstrated increased serum bilirubin levels. Mortality was considerably higher in hepatic patients than in non-hepatic patients, particularly among those with severe and critical COVID-19. The study suggests that liver disease is associated with the progression to severe COVID-19, which includes a higher risk of mortality. Conclusion COVID-19 is linked to liver function impairment, with hepatic patients experiencing higher mortality rates compared to non-hepatic patients. Summary COVID-19, a novel coronavirus, presents a serious health threat to both healthy individuals and those with pre-existing health conditions. In this study, we evaluated its impact on individuals with liver disease compared to those without. The findings indicate that COVID-19 infection is associated with a decline in liver function and increased mortality rates in patients with liver disease.

Chronic rhinosinusitis with nasal polyps (CRSwNP) symptom verbal response scales: content validity testing for use in adults with CRSwNP

BackgroundPRO measures of symptoms in clinical trials have historically utilized visual and numerical scales but verbal descriptors may make it easier for patients to clearly differentiate between response options. This study assessed content validity and meaningful change in five verbal response scales (VRSs) used to assess chronic rhinosinusitis with nasal polyp (CRSwNP) symptom severity.MethodologyThis qualitative, semi-structured interview study recruited adults from the US, Germany, and China with confirmed moderate-to-severe CRSwNP. Interviews included a concept elicitation section, where participants were asked about their experience of living with CRSwNP including symptoms and health-related quality-of-life impacts, and a cognitive debriefing section, where participants were debriefed and participant understanding and real-life relevance of the CRSwNP symptom VRS content were assessed. Interview transcripts were qualitatively analyzed using thematic analysis methods.ResultsAmong the 24 participants interviewed, the most frequently reported CRSwNP symptoms were nasal obstruction, runny nose, mucus in the throat, loss of smell and facial pain/pressure. Participants demonstrated good understanding of the CRSwNP symptom VRS instructions, items, recall period, and response options. The five CRSwNP symptom VRS items were relevant to the majority of participants’ experience of CRSwNP. At the item level, a one-category within-person improvement was the level most frequently reported by participants to be a meaningful change.ConclusionThe CRSwNP symptom VRSs assess relevant and bothersome symptoms experienced by patients with moderate-to-severe CRSwNP, supporting content validity of this measure. The findings of this study provided preliminary insights into meaningful change in the VRS. Further quantitative assessment of meaningful change is needed, and psychometric evaluation of the CRSwNP symptom VRSs will be required to evaluate their appropriateness for assessment of clinical trial endpoints in patients with CRSwNP.