Respiratory Reactions Research Articles

Seasonal Changes of Common Viral Infections in Children After Their Return to School During COVID-19 Pandemic

Abstract Introduction During the COVID-19 pandemic, return of children and adolescents to schools and colleges, with infections preventive restrictions, occurred in September 2020. In spring 2021, these restrictions were lifted. In this context, health systems noticed an apparent change in the seasonality and epidemiology of common viral infections in both adult and pediatric populations. Methods We retrospectively analyzed the results of respiratory virus polymerase chain reaction (PCR) carried out on pediatric nasopharynx samples, tested with multiplex PCR assay to detect the presence of common respiratory viruses. Results We reviewed a total of 1338 PCR samples from our microbiology laboratory. After the return to school, the most frequently identified virus was rhinovirus-enterovirus (27.8%), followed by respiratory syncytial virus (21%). An increase of positive respiratory syncytial virus PCRs was detected out of its common epidemic period from spring to summer of 2021. A peak in influenza virus infections was observed between March and May 2022. The lifting of restrictions due to COVID-19 had a significant impact on the type of virus detected. Conclusions We conclude that with the end of the COVID-19 pandemic, the return to school of children and adolescents, and lifting of preventative restrictions, the circulation of common viruses within this age group increased gradually, showing an unusual delay and peaks outside its epidemic periods.

Is pitolisant safe for clinical use? A retrospective pharmacovigilance study focus on the post-marketing safety.

Pitolisant, a novel histamine H3-receptor antagonist, holds significant promise for treating narcolepsy. However, a petition, which highlighted that pitolisant was associated with deaths during clinical trials, has propelled it into the spotlight of widespread societal attention on April 3, 2023. Till now, the clinical safety of pitolisant remains a heatedly debated topic. This study aimed to offer a comprehensive assessment of the safety profile of pitolisant in real-world clinical settings. Adverse event reports where pitolisant was the primary suspect drug were extracted from the FDA Adverse Event Reporting System database. The clinical characteristics and concomitant drugs of the pitolisant-associated adverse events were analyzed. The potential adverse event signals of pitolisant were explored using four disproportionality analysis methods. Furthermore, the difference in pitolisant-associated adverse event signals was investigated concerning sex, age, weight, and dose. A total of 526 reports and 1695 adverse events with pitolisant as the primary suspected drug were identified. The most significant adverse event signals were generally mild and of short duration. The concomitant drugs of pitolisant were highly intricate, mainly included drugs for treating narcolepsy as well as antidepressants. Seven new significant adverse event signals emerged. The safety profile of pitolisant exhibited no significant differences across age and dose groups, although slight variations were observed in relation to sex and weight. The findings from reports of death and life-threatening outcomes underscore the importance of enhanced monitoring for cardiac and respiratory adverse reactions when utilizing pitolisant. This study provided a broader understanding of the safety profile of pitolisant.

Simulation of human breathing gas exchange for the ventilation regulation study

The chemoreflex control of breathing plays a major role in human lung ventilation adjustment in response to metabolic demands and CO2, O2 partial pressure changes in the inhaled air. The extreme conditions, e.g. emergency work in mines or deep-sea diving, space flights, can change the respiratory system reaction to CO2 and O2. The study of the relevant respiratory system characteristics is an important fundamental and practical task. One of the convenient ways of research is mathematical simulation, which allows to reduce the number of experiments in extreme conditions or experiments for the personal protective equipment testing, as well as to forecast the estimated time of effective human work in such conditions. The model describes the dynamics of the gas content in the 3 compartments of the biological system and the external environment represented by the 4th compartment. The external environment can be limited by the volume of the device to which a person is connected, or by the volume of a closed hermetic object, or represented by a sufficiently large volume, conditionally being an atmosphere with appropriate parameters. A mathematical model of the breathing gas exchange with the external environment (the atmosphere or any other limited space) is presented. It is the first time, the simulation results of breathing at rest, during hyperventilation and rebreathing tests are presented, including gas dynamics in the pulmonary and tissue compartments, as well as in the brain compartment. Hypercapnia ventilation reaction during rebreathing tests with a hyperoxic - hypercapnic gas mixtures and different rebreathing bags in comparison with stationary methods of breathing control study. Verification of the model by simulation results with the literature data comparison showed the simulation model’s adequacy. A sensitivity table of the simulation model behavior in response to parameters changes is presented.

SnotWatch: data collaboration informing disease impact

The spectrum of health conditions associated with the circulation of respiratory viruses remains poorly quantified. The SnotWatch platform has established a databank containing test results for respiratory polymerase chain reaction tests conducted by eight major Victorian pathology laboratories and has obtained access to major healthcare presentation databases, such as the Victorian Admitted Episodes Dataset, Victorian Emergency Minimum Dataset and POLAR GP. By establishing a statistical approach to describe the associations between healthcare presentations and circulating viruses in space and time at a population level, SnotWatch is uncovering the health conditions associated with virus circulation. SnotWatch’s methods have been validated by demonstrating the capacity to describe well-known associations, but have also uncovered novel associations. Methods used have also been able to incorporate environmental exposures. By elucidating the associations between viruses and health conditions, SnotWatch allows clinicians to make better informed diagnoses, anticipate healthcare presentations and outcomes, optimises resource management by healthcare providers and allows the benefits of vaccination to be more fully appreciated. SnotWatch’s future includes establishing methods for attributable burden, developing models for nowcasting and deepening our understanding of the economic impact of viruses.

Cobalt Microinjections into the Infralimbic Cortex of the Anesthetized Rat Suppresses Circulatory and Respiratory Reactions to the Electrical Microstimulation of the Lateral Orbital Cortex

Cobalt Microinjections into the Infralimbic Cortex of the Anesthetized Rat Suppresses Circulatory and Respiratory Reactions to the Electrical Microstimulation of the Lateral Orbital Cortex

Recent guidelines addressing chronic rhinosinusitis with nasal polyps: practical aspects.

Chronic rhinosinusitis (CRS) is common in adults. It is diagnosed based on a high index of suspicion alongside objective means of assessing sinus inflammation. Determining the impact of CRS on patient quality of life is an important starting point for discussions regarding treatment, and is critical for longitudinal assessment of response to specific treatments. CRS can be further categorized by the presence or absence of nasal polyps. Recent Joint Task Force on Practice Parameters Grading of Recommendations Assessment, Development, and Evaluation guidelines for the management of CRS with nasal polyps (CRSwNP) focused on 3 treatment options: intranasal corticosteroids with multiple delivery methods, biologics (monoclonal antibodies targeting type 2 inflammation), and aspirin therapy after desensitization, which only applies to the subset of patients with CRSwNP who experience acute respiratory reactions following nonsteroidal anti‑inflammatory drug ingestion. The authors of the guidelines made conditional recommendations in favor of each of these 3 treatment options, highlighting the importance of shared decision‑making when choosing appropriate therapy for individuals with CRSwNP.

Nasal polyp antibody-secreting cells display proliferation signature in aspirin-exacerbated respiratory disease

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) causes nasal obstruction and olfactory dysfunction. Aspirin-exacerbated respiratory disease (AERD) is the triad of CRSwNP, asthma and respiratory reactions to cyclooxygenase-1 inhibitors. Patients with AERD have elevated nasal IL-5 levels and high numbers of antibody secreting cells (ASCs), plasma cells (PCs) and plasmablasts, in their polyp tissue, and nasal polyp IgE levels correlate with disease severity and recurrence of nasal polyposis. ObjectiveWe sought to explore differences in the transcriptomic profile, activation markers, and IL-5Rα expression and function of nasal polyp ASCs from patients with AERD and CRSwNP. MethodsNasal polyp tissue was collected from patients with AERD and CRSwNP and digested into single-cell suspensions. Nasal polyp cells were analyzed for protein expression by mass cytometry. For IL-5Rα functional studies, plasma cells were purified and cultured in vitro with/without IL-5 and analyzed by bulk RNA-sequencing. ResultsAERD polyp tissue contained significantly more ASCs and had increased ASC expression of IL-5Rα compared to CRSwNP. AERD ASCs expressed higher protein levels of B cell activation and regulatory markers (CD40, CD19, CD32, and CD38) and the proliferation marker Ki-67. AERD ASCs also expressed more IL5RA, IGHE, and cell cycle and proliferation-related transcripts (CCND2, MKI67, CDC25A and CDC25B) compared to CRSwNP. Stimulation of AERD PCs with IL-5 induced key cell cycle genes (CCND2 and PTP4A3), whereas IL-5 stimulation of ASCs from CRSwNP induced few transcriptomic changes. ConclusionNasal polyp tissue ASCs from patients with AERD express higher levels of functional IL-5Rα and markers associated with cell cycling and proliferation compared to those from aspirin-tolerant CRSwNP patients.

Co-administration of chicken IL-2 alleviates clinical signs and replication of the ILTV chicken embryo origin vaccine by pre-activating natural killer cells and cytotoxic T lymphocytes.

Chickens immunized with the infectious laryngotracheitis chicken embryo origin (CEO) vaccine (Medivac, PT Medion Farma Jaya) experience adverse reactions, hindering its safety and effective use in poultry flocks. To improve the effect of the vaccine, we sought to find a strategy to alleviate the respiratory reactions associated with the vaccine. Here, we confirmed that co-administering the CEO vaccine with chIL-2 by oral delivery led to significant alleviation of the vaccine reactions in chickens after immunization. Furthermore, we found that the co-administration of chIL-2 with the CEO vaccine reduced the clinical signs of the CEO vaccine while enhancing natural killer cells and cytotoxic T lymphocyte response to decrease viral loads in their tissues, particularly in the trachea and conjunctiva. Importantly, we demonstrated that the chIL-2 treatment can ameliorate the replication of the CEO vaccine without compromising its effectiveness. This study provides new insights into further applications of chIL-2 and a promising strategy for alleviating the adverse reaction of vaccines.

Nickel Content of Pineapple (Ananas comosus L.) and Banana (Musa sapientum L.) Sold in Gwagwalada Area Council, Abuja, Nigeria

Nickel is a heavy metal that can accumulate in plants, potentially posing health risks to consumers if present above recommended levels The present study aimed to determine the nickel (Ni) concentrations in pineapple and banana samples and assess their compliance with the World Health Organization/Food and Agriculture Organization (WHO/FAO) permissible limit for Ni in fruits. Banana and pineapple samples were randomly collected from Gwagwalada Area Council. Nickel concentrations were measured using Atomic Absorption Spectroscopy (AAS), Thermo Fisher ICE Model 3000. After acid digestion by Nitric acid. The results revealed mean Ni concentration of 355±3.44 mg/kg in banana and 333±6.58 mg/kg in pineapples. Comparing these concentrations with the WHO/FAO permissible limit of 67.9 mg/kg, both pineapple and banana samples significantly exceeded the recommended threshold. The nickel (Ni) concentration of banana was 5.2 times higher than the WHO/FAO permissible limit while that of pineapple was 4.9 times higher than the WHO/FAO permissible limit. There was no significant difference in the concentration of both fruits (p>0.05). The elevated Ni levels in these fruits could be attributed to several factors, including the bioavailability of Ni in the soil, farming practices, and environmental contamination. The outcomes of this study provided insights into the potential health risk that could be s associated with the consumption of pineapple and banana. However, this risk posed may depend on how often these fruits are consumed. Some studies have reported that chronic exposure to elevated levels of nickel can have adverse effects on human health, including respiratory issues, allergic reactions, and carcinogenicity. Monitoring of heavy metal content of fruits and other foods is recommended to prevent long term build up of nickel and other heavy metals in fruits and food crops.

Clinical Aspects and Etiologic Investigation of Pediatric Patients With Acute Liver Failure

A new outbreak of hepatitis of unknown origin raised awareness in the international community. A few reports have attempted to associate new cases with adenovirus infection and the immunologic effects of previous SARS-CoV-2 infections through a superantigen mechanism. Moreover, according to a case series, viral isolates were identified in 7 of 10 cases of pediatric patients with hepatitis of unknown origin and acute liver failure. Adenovirus was detected by respiratory secretion polymerase chain reaction in 2 patients, with neither presenting with SARS-CoV-2 acute infection. Clinical and laboratory descriptions and cross-referencing epidemiologic and pathophysiological data can help identify possible disease etiologies.

Effect of Uneven Microclimates in Poultry Yards on the Respiratory System of Poultry

The respiratory system of birds is maximally adapted to the high efficiency of air exchange necessary to maintain an increased level of metabolic processes. The mucus of the respiratory tract plays an important role in mucociliary clearance, in the normal state of the respiratory system, without allergic and inflammatory reactions, an increase in the amount of mucus and the structures that produce it can be interpreted as a positive fact, but too much mucus can be a response to mucosal irritation and contributes to airway obstruction. As a result of two studies repeating each other, the dependence of the state of the tracheal wall in Ross-308 cross broilers on air circulation in industrial premises was confirmed. Ensuring the circulation of air flows in poultry rearing halls has a positive effect on the histological and histochemical structure of the trachea. In the first experiment, this is reliably evidenced by an increase in the thickness of the epithelial layer by 1.3 times (by 23.3%) and the height of the cilia by 3.1 times (by 67.5%). In the second experiment, this is confirmed by an increase in the height of the epithelium by 40% and the height of the cilia layer by 70%. In addition, the histological picture of the mucosa corresponds to the norm, there are no violations of the integrity of the epithelium, the cilia are smooth, without deformations and creases. With the provision of air circulation in closed rooms in the first experiment, the thickness of the tracheal mucosa decreases by 2.6 times (by 61.9%), and its own plate by 2.9 times (by 65.4%). In the second experiment, no such pattern was found in the own plate, but destructive changes in the tracheal mucosa, an increase in the number of glycoproteins and proteoglycans in the experimental groups confirm the influence of the ventilation factor.

Questionnaire study suggests grave consequences of infectious laryngotracheitis, infectious coryza and mycoplasmosis in small chicken flocks

BackgroundA growing number of people in western countries keep small chicken flocks. In Sweden, respiratory disease is a common necropsy finding in chickens from such flocks. A respiratory real-time polymerase chain reaction (PCR) panel was applied to detect infectious laryngotracheitis virus (ILTV), Avibacterium paragallinarum (A. paragallinarum) and Mycoplasma gallisepticum (M. gallisepticum) in chickens from small flocks which underwent necropsy in 2017–2019 and had respiratory lesions. Owners (N = 100) of PCR-positive flocks were invited to reply to a web-based questionnaire about husbandry, outbreak characteristics and management.ResultsResponse rate was 61.0%. The flocks were from 18 out of Sweden’s 21 counties indicating that respiratory infections in small chicken flocks are geographically widespread in Sweden. Among participating flocks, 77.0% were coinfected by 2–3 pathogens; 91.8% tested positive for A. paragallinarum, 57.4% for M. gallisepticum and 50.8% for ILTV. Larger flock size and mixed-species flock structure were associated with PCR detection of M. gallisepticum (P = 0.00 and P = 0.02, respectively). Up to 50% mortality was reported by 63.9% of respondents. Euthanasia of some chickens was carried out in 86.9% of the flocks as a result of the outbreaks. Full clinical recovery was reported by 39.3% of owners suggesting chronic infection is a major challenge in infected flocks. Live birds had been introduced in many flocks prior to outbreaks, which suggested these as an important source of infection. Following the outbreaks, 36.1% replaced their flocks with new birds and 9.8% ceased keeping chickens.ConclusionsThis study highlights the severity of respiratory outbreaks in small non-commercial chicken flocks and points to the need for more research and veterinary assistance to prevent and manage respiratory infections in small chicken flocks.

Respiratory hypersensitivity reaction related to ingestion of raspberry

A 27‐year‐old woman developed dyspnea and wheezing within 10 min after eating a piece of raspberry walnut cake, and was successfully treated with intravenous corticosteroid and intramuscular injection of adrenaline. An open oral provocation test with raspberry demonstrated immediate respiratory hypersensitivity reaction.

Perioperative mepolizumab in aspirin-exacerbated respiratory disease does not prevent nasal polyp regrowth

Aspirin-exacerbated respiratory disease (AERD) is defined by the triad of asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and respiratory reactions to medications that inhibit cyclooxygenase-1. Of these elements, patients with AERD cite CRSwNP symptoms as the most impactful on quality of life1. Patients with AERD are less likely to respond to first-line therapy with intranasal glucocorticoids and more likely to require multiple functional endoscopic sinus surgeries (FESS) compared to aspirin-tolerant CRSwNP2. Histologically, nasal tissue eosinophil levels are higher in patients with AERD compared to those in aspirin-tolerant patients with CRSwNP3. These findings together emphasize the need for effective CRSwNP treatments and suggest a possible role for eosinophil-targeting agents in AERD. However, near-total depletion of nasal polyp tissue eosinophils with dexpramipexole failed to improve symptoms and reduce polyp burden among patients with CRSwNP, which suggests eosinophils alone may not be the primary drivers of tissue inflammation in patients with CRSwNP4,5.

Leveraging Influenza Virus Surveillance From 2012 to 2015 to Characterize the Burden of Respiratory Syncytial Virus Disease in Canadian Adults ≥50 Years of Age Hospitalized With Acute Respiratory Illness.

Respiratory syncytial virus (RSV) disease in older adults is undercharacterized. To help inform future immunization policies, this study aimed to describe the disease burden in Canadian adults aged ≥50 years hospitalized with RSV. Using administrative data and nasopharyngeal swabs collected from active surveillance among adults aged ≥50 years hospitalized with an acute respiratory illness (ARI) during the 2012-2013, 2013-2014, and 2014-2015 influenza seasons, RSV was identified using a respiratory virus multiplex polymerase chain reaction test to describe the associated disease burden, incidence, and healthcare costs. Of 7797 patients tested, 371 (4.8%) were RSV positive (2.2% RSV-A and 2.6% RSV-B). RSV prevalence varied by season from 4.2% to 6.2%. Respiratory virus coinfection was observed in 11.6% (43/371) of RSV cases, with influenza A being the most common. RSV hospitalization rates varied between seasons and increased with age, from 8-12 per 100 000 population in adults aged 50-59 years to 174-487 per 100 000 in adults aged ≥80 years. The median age of RSV cases was 74.9 years, 63.7% were female, and 98.1% of cases had ≥1 comorbidity. Among RSV cases, the mean length of hospital stay was 10.6 days, 13.7% were admitted to the intensive care unit, 6.4% required mechanical ventilation, and 6.1% died. The mean cost per RSV case was $13 602 (Canadian dollars) but varied by age and Canadian province. This study adds to the growing literature on adult RSV burden by showing considerable morbidity, mortality, and healthcare costs in hospitalized adults aged ≥50 years with ARIs such as influenza.

Extracellular Vesicles - Effectors of Transfusion-related Acute Lung Injury.

Respiratory transfusion reactions represent some of the most severe adverse reactions related to receiving blood products. Of those, transfusion-related acute lung injury (TRALI) is associated with elevated morbidity and mortality. TRALI is characterized by severe lung injury associated with inflammation, pulmonary neutrophil infiltration, lung barrier leak, and increased interstitial and airspace edema which cause respiratory failure. Presently, there are few means of detecting TRALI beyond clinical definitions based on physical examination and vital signs or preventing/treating TRALI beyond supportive care with oxygen and positive pressure ventilation. Mechanistically, TRALI is thought to be mediated by the culmination of two successive pro-inflammatory hits, which typically comprise a recipient factor (1st hit - e.g. systemic inflammatory conditions) and a donor factor (2nd hit - e.g. blood products containing pathogenic antibodies or bioactive lipids). An emerging concept in TRALI research is the contribution of extracellular vesicles (EVs) in mediating the 1st and/or 2nd hit in TRALI. EVs are small, sub-cellular, membrane-bound vesicles which circulate in donor and recipient blood. Injurious EVs may be released by immune or vascular cells during inflammation, by infectious bacteria, or in blood products during storage, and can target the lung upon systemic dissemination. This review assesses emerging concepts such as how EVs: i) mediate TRALI, ii) represent targets for therapeutic intervention to prevent or treat TRALI, and iii) serve as biochemical biomarkers facilitating TRALI diagnosis and detection in at-risk patients.

Automated Identification of Aspirin-Exacerbated Respiratory Disease Using Natural Language Processing and Machine Learning: Algorithm Development and Evaluation Study.

Aspirin-exacerbated respiratory disease (AERD) is an acquired inflammatory condition characterized by the presence of asthma, chronic rhinosinusitis with nasal polyposis, and respiratory hypersensitivity reactions on ingestion of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Despite AERD having a classic constellation of symptoms, the diagnosis is often overlooked, with an average of greater than 10 years between the onset of symptoms and diagnosis of AERD. Without a diagnosis, individuals will lack opportunities to receive effective treatments, such as aspirin desensitization or biologic medications. Our aim was to develop a combined algorithm that integrates both natural language processing (NLP) and machine learning (ML) techniques to identify patients with AERD from an electronic health record (EHR). A rule-based decision tree algorithm incorporating NLP-based features was developed using clinical documents from the EHR at Mayo Clinic. From clinical notes, using NLP techniques, 7 features were extracted that included the following: AERD, asthma, NSAID allergy, nasal polyps, chronic sinusitis, elevated urine leukotriene E4 level, and documented no-NSAID allergy. MedTagger was used to extract these 7 features from the unstructured clinical text given a set of keywords and patterns based on the chart review of 2 allergy and immunology experts for AERD. The status of each extracted feature was quantified by assigning the frequency of its occurrence in clinical documents per subject. We optimized the decision tree classifier's hyperparameters cutoff threshold on the training set to determine the representative feature combination to discriminate AERD. We then evaluated the resulting model on the test set. The AERD algorithm, which combines NLP and ML techniques, achieved an area under the receiver operating characteristic curve score, sensitivity, and specificity of 0.86 (95% CI 0.78-0.94), 80.00 (95% CI 70.82-87.33), and 88.00 (95% CI 79.98-93.64) for the test set, respectively. We developed a promising AERD algorithm that needs further refinement to improve AERD diagnosis. Continued development of NLP and ML technologies has the potential to reduce diagnostic delays for AERD and improve the health of our patients.

Kawasaki Disease and Respiratory Viruses: Ecological Spatiotemporal Analysis.

Kawasaki disease is an uncommon vasculitis affecting young children. Its etiology is not completely understood, although infections have been frequently postulated as the triggers. Respiratory viruses, specifically, have often been implicated as causative agents for Kawasaki disease presentations. We aimed to conduct an ecological spatiotemporal analysis to determine whether Kawasaki disease incidence was related to community respiratory virus circulation in a shared region and population, and to describe viral associations before and during the COVID-19 pandemic. We obtained independent statewide data sets of hospital admissions of Kawasaki disease and respiratory multiplex polymerase chain reaction tests performed at two large hospital networks in Victoria, Australia, from July 2011 to November 2021. We studied spatiotemporal relationships by negative binomial regression analysis of the monthly incidence of Kawasaki disease and the rate of positive respiratory polymerase chain reaction tests in different regions of Victoria. Peak viral seasons (95th percentile incidence) were compared to median viral circulation (50th percentile incidence) to calculate peak season increased rate ratios. While no seasonal trend in Kawasaki disease incidence was identified throughout the study period, we found a 1.52 (99% CI 1.27-1.82) and a 1.43 (99% CI 1.17-1.73) increased rate ratio of Kawasaki disease presentations in association with human metapneumovirus and respiratory syncytial virus circulation, respectively, before the COVID-19 pandemic. No respiratory viral associations with Kawasaki disease were observed during the COVID-19 pandemic. Our large ecological analysis demonstrates novel spatiotemporal relationships between human metapneumovirus and respiratory syncytial virus circulation with Kawasaki disease. The disappearance of these associations in the COVID-19 pandemic may reflect the reduced circulation of non-SARS-CoV-2 viruses during this period, supporting the prepandemic associations identified in this study. The roles of human metapneumovirus and respiratory syncytial virus in Kawasaki disease etiology warrant further investigation.

Deterioration of lung function and its association with eosinophil count.

Exposure to lethal dust particles has a negative impact on human's health. This work investigated the association between respiratory symptoms and eosinophil levels between quarry workers and the controls. A total of 75 workers exposed to quarry dust and 45 age, sex, body mass index-matched unexposed controls participated in this study. Results of this study indicated that the quarry dust particles produced inflammatory responses, increasing the mean eosinophil level (7.56 ± 2.94), causing allergic respiratory symptoms such as rhinitis , chest tightness, wheeze, sputum production thus impairing the lung function with decline in FEV1(80.84 ±108.8) level in workers exposed to quarry dust compared to controls (P≤0.00**) Conclusion: The presence of increased levels of respiratory irritants in quarry sites may explain the higher prevalence of respiratory infections and exacerbated inflammatory reactions found to ascertain the link between increased eosinophil count and the lung impairment in quarry workers.

Characteristics and Treatments of Coronavirus Disease 2019 Patients Presenting With Persistent Hiccups: A Scoping Review.

Over the time of the pandemic, coronavirus disease 2019 (COVID-19) has surprised us with a growing list of atypical presentations, one of which is persistent hiccups that last more than 48 hours. The aim of this review is to investigate the characteristics of COVID-19 patients presenting with persistent hiccups and explore treatments used to control persistent hiccups in such cases. This scoping review was performed utilizing the methodological approach proposed by Arksey and O'Malley. Fifteen relevant cases were identified. All reported cases were males, aged between 29 and 72 years. More than one-third of the cases did not have symptoms of infection. All cases had a positive severe acute respiratory syndrome coronavirus reverse transcriptase-polymerase chain reaction, as well as lung involvement evident on chest imaging. The medications most frequently used for hiccups in the reported cases were chlorpromazine (6 cases, 83% success), metoclopramide (5 cases, 0% success), and baclofen (3 cases, 100% success). In patients presenting with persistent hiccups during this pandemic, even in those lacking systemic or other manifestations of COVID-19 or pneumonia, clinicians are encouraged to consider COVID-19 as one of the differential diagnoses. In light of the findings of this review, it is recommended to include a severe acute respiratory syndrome coronavirus reverse transcriptase-polymerase chain reaction test and a chest imaging as part of the workup for these patients. When considering treatment options, this scoping review shows that chlorpromazine has more favorable outcomes compared with metoclopramide for controlling persistent hiccups in COVID-19 patients.