Respiratory Tract Symptoms Research Articles

English

In early January 2020, China had started raising concerns of a new contagious disease caused by new strains of coronavirus, Severe Acute Respiratory SyndromeCoronavirus-2 (SARS-CoV-2). The World Health Organization (WHO) on March 11, 2020, had declared the novel coronavirus (COVID-19) outbreak a global pandemic. COVID-19 was transmitted from person to person through respiratory droplets generated when an infected person coughs, sneezes, breathing or through contact with a surface that has been contaminated 1 and through aerosols-airborne microdroplets.2 The clinical manifestations of COVID-19 represents a wide spectrum of disease ranging from mild to severe respiratory syndrome influenza-like illness with mainly lower respiratory tract symptoms, complicated by pneumonia and Acute Respiratory Distress Syndrome (ARDS), high fever, and headache. In many cases, loss of taste and smell and severe gastrointestinal symptoms were reported, as are cardiac problems, with the latter being perhaps secondary to a cytokine storm such as is seen in the more severely affected patients. 3 WHO COVID-19 dashboard on June 25th 2021 showed 179, 686, 071 confirmed cases worldwide.

Bilateral Abducens Nerve Palsy and the possible Association with COVID-19: A Case Report

Cranial nerve neuropathy could be a part of neurological spectrum of COVID-19 disease. Research suggests SARS-CoV-2 infection can trigger an aberrant immune response in some individuals, causing inflammatory nerve damage leading to anosmia and neuropathy. We report here a 50-year-old female patient who presented to the outpatient clinic in Saint John Eye Hospital with a two months history of binocular, horizontal diplopia five days after recovery from SARS-CoV-2 infection, PCR positive test obtained by a nasopharyngeal swab on April 1st, 2021 with upper respiratory tract symptoms. The patient was diagnosed with bilateral abducens nerve palsy. The main cause was presumed to be post-viral as the patient had controlled diabetes “HBA1C: 7%” and had no pre-existing microvascular risk factors. Diplopia still exists after two months of bilateral abducens nerve palsy. Measurements confirmed bilateral limited abductions in both eyes with right or alternating convergent squint. This case report supports the hypothesis that direct or indirect virally mediated injuries along the routes of the cranial nerves can cause neuropathy and olfactory dysfunction. The longer latency effects of COVID-19 infection are not well understood. This case report aims to raise awareness amongst clinicians of coronavirus-induced neurological symptoms

Examination and counseling of gynecological cases during Corona Virus Disease 2019 (COVID-19) pandemic

HIGHLIGHTS1. Clinical gynecology examinations must adapt to pandemic situation.2. It must pay attention to universal precautions, aseptic and sterile technique to minimize infection transmission.3. In terms of reducing contact, the need for examination are divided by priority into "now", "soon", or "later".4. Gynecology examinations can be carried out with direct examinations by medical personnel wearing proper personal protective equipment if needed.5. Patient counseling can be done by remote consultation or telemedicine. ABSTRACTCOVID-19 is a recent pandemic caused by the SARS COV-2 agent with a high incidence and mortality. The disease is transmitted through respiratory droplets and direct contact. Clinically this COVID-19 patient is mainly related to the respiratory tract symptoms. The current clinical classifications are divided into suspected, probable, and confirmed cases. To reduce transmission must pay attention to universal and hierarchical precaution, aseptic standards, and sterile techniques. The types of gynecological examinations during a pandemic are the same as those in general, except that the methods, settings, and priorities are different. The examination begins with screening to assess the risk of transmission so that it can determine the place of examination. The urgency of the examination, history of TOCC, local transmission, provider, and room conditions also need to be considered. Counseling during a pandemic can be done in person or by telemedicine. Counseling is provided for general and case-specific gynecological information. Each gynecological case requires a different focus on counseling.

Probiotics with vitamin C for the prevention of upper respiratory tract symptoms in children aged 3-10 years: randomised controlled trial.

In a double-blind, randomised, parallel-group, placebo-controlled study, healthy school children aged 3-10 years received a probiotic based supplement daily for 6 months to assess the impact on the incidence and duration of upper respiratory tract infection (URTI) symptoms. The intervention comprised Lab4 probiotic (Lactobacillus acidophilus CUL21 and CUL60, Bifidobacterium bifidum CUL20 and Bifidobacterium animalis subsp. lactis CUL34) at 12.5 billion cfu/day plus 50 mg vitamin C or a matching placebo. 171 children were included in the analysis (85 in placebo and 86 in active group). Incidence of coughing was 16% (P=0.0300) significantly lower in the children receiving the active intervention compared to the placebo. No significant differences in the incidence rate of other URTI symptoms were observed. There was significantly lower risk of experiencing five different URTI related symptoms in one day favouring the active group (Risk ratio: 0.31, 95% confidence interval: 0.12, 0.81, P=0.0163). Absenteeism from school and the use of antibiotics was also significantly reduced for those in the active group (-16%, P=0.0060 and -27%, P=0.0203, respectively). Our findings indicate that six months daily supplementation with the Lab4 probiotic and vitamin C combination reduces the incidence of coughing, absenteeism and antibiotic usage in 3 to 10 year old children.

Белок профилин как клинически значимый паналлерген в развитии синдрома пыльцевой и пищевой аллергии

Профилин играет важную роль в качестве сенсибилизатора и фактора, представляющего трудности как в диагностике, так и в лечении пациентов с пыльцевой и растительной пищевой аллергией. В контролируемых исследованиях профилин доказал свою способность вызывать различные симптомы заболеваний верхних и нижних дыхательных путей. До конца не изучено клиническое значение профилинов в развитии респираторных заболеваний в реальных условиях воздействия, и в какой степени это способствует появлению симптомов. Крупные эпидемиологические исследования показали, что профилин является маркером тяжести заболевания и полисенсибилизации при аллергии на травы, а сенсибилизация к rPhl p 12 статистически связана с большей длительностью заболевания и оральным аллергическим синдромом к растительной пище. Роль профилина в развитии орального аллергического синдрома на растительные продукты питания была признана у пациентов с аллергией на пыльцу. Кроме того, профилин может вызывать системные реакции на растительную пищу в отдельных группах населения, которые обычно сталкиваются с сезонами с высоким уровнем пыльцы травы. Несмотря на то, что профилин считается второстепенным аллергеном, он является основным аллергеном некоторых растительных продуктов, например дыни (Cuc m 2), апельсина и сои. Аллергия на дыню, арбуз, цитрусовые, помидоры и бананы, как сообщается, является клиническим маркером гиперчувствительности к профилину. Его значение у лиц с аллергией на латекс остается низким или он вообще не имеет значения согласно некоторым публикациям. Невзирая на вышеупомянутую актуальность, не существует надежного терапевтического подхода к лечению аллергии на белок профилин. Более того, у пациентов с сенсибилизацией к профилину аллерген-специфическая иммунотерапия не показана ввиду недостаточного количества минорных компонентов в препаратах для данного вида терапии, а пищевая иммунотерапия недостаточно изучена. Таким образом, профилактические стратегии, а именно элиминационные мероприятия и симптоматическая терапия, могут быть оптимальным вариантом лечения для пациентов, чувствительных к профилину.

Little Hearts Are Affected by COVID19: Importance of the Myocardial Systolic Evaluation.

Background: Identifying the cardiac changes could help design measures to recover the cardiovascular system and lessen the mortality and morbidity rate. Accordingly, this cross-sectional study was performed to evaluate the echocardiography indices which are indicators of the cardiac alterations of the children with COVID19 infection.Methods: This study was performed as a cross-sectional study evaluating echocardiography indices in children infected with COVID19. Fifteen children, known cases of the COVID19, and 14 healthy children were enrolled. Evaluated parameters include left ventricle ejection fraction (LVEF), left ventricle end-diastolic diameter (LVED), mitral valve Sa (MV Sa), Tricuspid annular plane systolic excursion (TAPSE), and laboratory parameters.Results: The participants' mean age and weight were 62.8 (±48.0) months and 19.95 (±15.67) kg, respectively. None of the laboratory and echocardiography parameters differed between males and females, between patients with and without positive past medical history, between the patients with and without respiratory tract symptoms, and between patients with and without GI tract symptoms (P.0.05). Patients had significantly higher TAPSE (p = 0.027), although MV Sa (p = 0.01) was significantly higher among healthy children. LV EF (p = 0.425) and LVED diameter (p = 0.603) were not different significantly. None of the patients had pericardial effusion, pleural effusion, and cardiac tamponade.Conclusion: The heart can be involved during the disease course in children, even at the level of echocardiography indices. This could contribute to a worse prognosis, higher morbidity, and mortality rate, especially in patients with overt myocardial involvement. Non-classic indicators, including LVEF, may not be conclusive for cardiac involvement in non-symptomatic patients.

Characteristics and Laboratory Findings of Food-Induced Anaphylaxis in Children: Study in an Asian Developing Country

Introduction: Food allergy is the major cause of pediatric anaphylaxis. Characteristics and triggers may be different in different geographical regions. Studies focusing on food-induced anaphylaxis (FIA) in Asian developing countries are limited. Our study aimed to study characteristics of FIA in a tertiary care center in an Asian developing country. Methods: Retrospective review of pediatric anaphylaxis admission and outpatient visit at a tertiary care hospital in Bangkok, Thailand during 2008–2018 was performed. Data regarding clinical presentation, place reaction occurred, time of onset, investigations (serum tryptase, specific immunoglobulin E, and skin test), treatment, and follow-up periods were collected. Results: One hundred seventy-four anaphylaxis admission records of which 61 episodes of FIA were retrieved. Data from outpatients visit consisted of 17 patients. Most patients were male (76.7%). The median age was 7.1 years (interquartile range 1.9–12.4). The major causes of FIA were shrimp/shellfish (37%), wheat (15.1%), and cow’s milk (11%). Food causing anaphylaxis varied according to age-group: infants had anaphylactic reactions to egg, wheat, and cow’s milk, preschools to wheat and peanut, and older children to shrimp/shellfish. Cutaneous manifestations occurred in all patients, followed by lower respiratory tract symptoms (83.6%) and gastrointestinal symptoms (50.8%). There was no biphasic anaphylaxis reported. Elevated serum tryptase was found in only 4 patients (7%). Conclusion: Recognizing characteristics of pediatric FIA is crucial. The common causes of FIA in our study in Asian children were egg in infants, wheat and peanut in preschool children, and shrimp/shellfish in school-age children and adolescents. Skin manifestation presented in all patients with FIA.

Comparative assessment of reported symptoms of influenza, respiratory syncytial virus, and human metapneumovirus infection during hospitalization and post-discharge assessed by Respiratory Intensity and Impact Questionnaire.

BackgroundThe hospitalized acute respiratory tract infection (HARTI) study used the Respiratory Intensity and Impact Questionnaire (RiiQ™) Symptom Scale, derived from FluiiQ™, to assess and compare the burden of respiratory infection symptoms for patients with influenza, respiratory syncytial virus (RSV), and human metapneumovirus (hMPV) infection, with or without core risk factors (CRF) (age ≥65; chronic heart, renal, obstructive pulmonary disease; asthma).MethodsThis was a prospective cohort study in adult patients hospitalized with acute respiratory tract infection (40 centers, 12 countries) during two consecutive influenza/RSV/hMPV seasons (2017–2019). The RiiQ™ Symptom Scale and EuroQol 5‐Dimensions 5‐Levels (EQ‐5D‐5L) were assessed by interview at two timepoints during hospitalization and at 1, 2, and 3 months post‐discharge.ResultsMean lower respiratory tract (LRT) symptom scores were higher for RSV and hMPV participants compared to influenza at 48 h after enrollment/early discharge (p = 0.001) and 3 months post‐discharge (p = 0.007). This was driven by LRT symptoms, including shortness of breath (SOB) (p < 0.01) and wheezing (p < 0.01) during hospitalization, and SOB (p < 0.05) and cough (p < 0.05) post‐discharge. Participants with CRF reported more moderate‐to‐severe SOB (p < 0.05) and wheezing (p < 0.05) compared to CRF(−) participants post‐discharge. EQ‐5D‐5L scores were moderately associated with RiiQ™ LRT and systemic symptoms domains.ConclusionsResults from the HARTI study suggest that in the study population, LRT symptoms were more severe for RSV and hMPV groups and for patients with CRF. RiiQ™ Symptom Scale scores shows a moderate association with EQ‐5D‐5L indicating that the RiiQ™ may provide useful insights and offer advantages over other measures for use in interventional RSV adult clinical studies.

Investigation of MERS-CoV seropositivity among Umrah visitors from the Çorum Region of Turkey

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) causes Middle East Respiratory Syndrome (MERS). Since the vast majority of cases (more than 85%) are reported from Saudi Arabia, there is a pandemic potential for pilgrimage due to Hajj or Umrah. It is reported from Turkey that more than 400 thousand people went to Saudi Arabia for umrah and 61 thousand people for Hajj in 2014. In this study it is aimed to investigate the patients who had just returned from Makkah for Umrah and who also applied to the Infectious Disease Clinics at the Hitit University Erol Olcok Training and Research Hospital for having respiratory tract symptoms. Their serologic situations have been determined by ELISA whether there is any risk in terms of performing the Hajj and Umrah, and contracting MERS-CoV. Between January 1st to the 31st of October 2015, 40 people were included in this study, which were admitted to our hospital with upper respiratory tract complaints and had previously been in Saudi Arabia for Umrah within the last 15 days. As a control group, 40 healthy people without any complaints and travel histories to risky areas were selected. Their serum samples were taken and searched by MERS-CoV IgG ELISA (Euroimmun AG, Lübeck, Germany). The results ≤0.8 were considered as negative, ≥1.1 were as positive, 0.8-1.1 were suspected. All suspected and positive results have been revaluated and confirmed. Only two (5%) individuals from the patients’ group were found as positive for the MERS-CoV IgG antibodies, but individuals from the remaining patients’ group and also all control group members were determined as negative. Travels to Saudi Arabia could be a risk for exposure to MERS-CoV. Although there is no evidence, contamination could be realized by anthropologically due to crowds.

Two different methods of lidocaine inhalation before diagnostic flexible bronchoscopy: effects on post-bronchoscopy respiratory symptoms

Use of topical anesthesia before flexible bronchoscopy for the evaluation of the upper airways prevents cough and stridor during and after the procedure while reducing the need for sedation. In practice, lidocaine is the medication of choice before bronchoscopy. There various types of nebulizers used for inhalation treatments. In this study, we compared the respiratory tract symptoms after flexible bronchoscopy between children who received pre-procedure topical lidocaine with mesh or jet nebulizers. We enrolled 4–18 years old subjects that underwent flexible bronchoscopy due to treatment-resistant asthma in this retrospective case-control study. Twenty subjects received topical lidocaine with jet nebulizers while 20 received it with mesh nebulizers. Age, sex, duration of bronchoscopy, duration of anesthesia, time to awaken, and time to recovery were recorded as well as cough and laryngospasm scores after flexible bronchoscopy. Severe cough after flexible bronchoscopy was not encountered in the mesh nebulizers group but was seen in 10% of the jet nebulizers group (p = 0.027). On the other hand, age, sex, duration of bronchoscopy, duration of anesthesia, time to awaken, and time to recovery were not significantly different between the mesh and jet nebulizer groups (p = 0.44, 0.34, 0.51, 0.88, 0.88, and 0.22, respectively). Moreover, croup and laryngospasm scores between the two groups were similar (p = 0.62, 0.50 respectively). Cough score was significantly worse jet nebulizers group (p = 0.03). Topical lidocaine application with mesh nebulizers decreases the most common complication, cough, after flexible bronchoscopy in children more effectively compare to jet nebulizers. Thus, mesh nebulizers may be a faster way of nebulization before flexible bronchoscopy as an alternative to jet nebulizers.

Clinical Findings among Patients with Respiratory Symptoms Related to Moisture Damage Exposure at the Workplace-The SAMDAW Study.

Background: Respiratory tract symptoms are associated with workplace moisture damage (MD). The focus of this observational clinical study was patients with workplace MD-associated symptoms, to evaluate the usefulness of different clinical tests in diagnostics in secondary healthcare with a special interest in improving the differential diagnostics between asthma and laryngeal dysfunction. Methods: In patients referred because of workplace MD-associated respiratory tract symptoms, we sought to systematically assess a wide variety of clinical findings. Results: New-onset asthma was diagnosed in 30% of the study patients. Laryngeal dysfunction was found in 28% and organic laryngeal changes in 22% of the patients, and these were common among patients both with and without asthma. Most of the patients (85%) reported a runny or stuffy nose, and 11% of them had chronic rhinosinusitis. Atopy was equally as common as in the general population. Conclusions: As laryngeal changes were rather common, we recommend proper differential diagnostics with lung function testing and investigations of the larynx and its functioning, when necessary, in cases of prolonged workplace MD-associated symptoms. Chronic rhinosinusitis among these patients was not uncommon. Based on this study, allergy testing should not play a major role in the examination of these patients.

Systemic manifestations and treatment algorithm of food allergy

Food allergy or hypersensitivity can be defined as the presence of an observable immune secondary reaction to the administration of certain proteins that are present within the ingested foods. It has been previously estimated that around 2-10% of the general population suffer from IgE-mediated food allergy. Furthermore, identification of the manifestations is a key point to achieve appropriate evaluation and management of this condition. In this literature review, we aim to discuss the systemic manifestations and treatment algorithm for patients who suffer from a food allergy, according to the current evidence from studies in the literature. Gastrointestinal and skin-related manifestations have been reported to be the most common symptom. However, respiratory tract symptoms are also common and might severely deteriorate the affected patients. The development of severe anaphylaxis is also life-threatening with multiple organ affection. The appropriate management of food hypersensitivity is mainly based on the proper intervention from exposure to the related allergens. In addition, another appropriate management is early sensitization during the first few months of infancy to manage the symptoms of affected patients. Additionally, it should also be noted that most children usually develop tolerance, and the reported allergy to certain types of foods during childhood usually fades away by the age from 8 to12 years old and also during the period of adolescence. Future studies are needed to develop adequate management modalities with favorable safety and efficacy outcomes.

Coronavirus Infection of the Urinary Bladder and Lower Urinary Tract: A Review and Update

COVID-19 infection does affect males and females. Even though the commonest manifestations of COVID-19 infection tend to be related to symptoms associated with the respiratory tract, many other organs of the body also tend to be affected and COVID-19 infection of these other organs could manifest contemporaneously with symptoms of the respiratory tract system in addition to symptoms of the affected organs. At times COVID-19 may initially manifest solely related to non-respiratory tract organs and because the symptoms are non-specific without a high index of suspicion, the diagnosis of COVID-19 infection may be missed initially or there may be delay in the diagnosis which would tend to lead to spreading of the disease. Some of the manifestations of COVID-19 infection of the urinary bladder may include: Lower urinary tract symptoms of urinary frequency, and or urinary urgency, and or nocturia, and or urinary incontinence, or on rare occasions non-visible or visible haematuria, or acute retention of urine. The aforementioned symptoms may occur as De novo (new-onset) symptoms alone or they may be associated with or without fever, with or without respiratory tract symptoms. Some individuals who already have lower urinary tract symptoms could experience worsening of their previous lower urinary tract symptoms and if the clinician does not have a high index of suspicion for the possible development of COVID-19 infection, and the clinician does blame the symptoms on benign prostatic hyperplasia then the diagnosis could be missed or delayed. If the COVID-19 cystitis is associated with COVID-19 infection of the male genital tract then some of the patients could experience scrotal discomfort, swelling of the scrotum, erythema of the scrotum, or low-flow priapism or clinical and radiology imaging features of acute orchitis, or acute epididymitis, or acute epididymo-orchitis. However, if the lower urinary tract symptoms are associated with respiratory tract symptoms all clinicians globally are aware of the fact that a high index of suspicion for COVID-19 infection should be exercised. What is important is that every clinician and every individual should be made aware of the fact that the development of De novo lower urinary tract symptoms or sudden onset of worsening lower urinary tract symptoms should be regarded as possibly due to COVID-19 infection and appropriate tests should be undertaken to confirm or negate the diagnosis of COVID-19 infection quickly. Diagnosis of COVID-19 infection of the urinary bladder can be confirmed the undertaking of various COVID-19 infection tests but COVID-19 PCR test has tended to be a common test that most people use globally.

Characteristics and Outcomes of COVID-19 Patients Admitted to Intensive Care Units in a Large Health System in Western Pennsylvania.

ImportanceDespite growing literature, there is still limited understanding of factors that can predict outcomes in coronavirus disease 2019 (COVID-19) patients who require intensive care.ObjectiveTo evaluate the characteristics of COVID-19 patients admitted to the intensive care unit (ICU) and identify their associations with outcomes.BackgroundThere are limited data on the outcomes in COVID-19 patients in Pennsylvania.DesignRetrospective studySettingIntensive care units in an academic health system in Western Pennsylvania.ParticipantsPatients with reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 admitted to ICUs as direct admission or transfers from regular floors between March 1, 2020, and April 30, 2020.Main outcome(s) and measure(s)The primary outcome was inpatient mortality. Secondary outcomes included complications during ICU stay, hospital length of stay, discharge disposition, and the need for oxygen at discharge. Categorical variables are described as frequencies and continuous variables as median with interquartile range (IQR). Regression modeling was used to identify the predictors of inpatient mortality in these patients. P-value <0.05 was considered statistically significant. Analysis was performed using Stata version 15.1 (StataCorp, College Station, Texas).ResultsThe cohort included 58 consecutive patients, with a median age of 62 years (IQR 54-73), 63.8% of which were male. On presentation, constitutional symptoms were the most common (91.4%), followed by lower respiratory tract symptoms (87.9%). Tachypnea (65.5%) and hypoxia (67.2%) were the most common abnormal vital signs at presentation. Common comorbidities were cardiovascular disease (74.1%), obesity (53.5%), and diabetes (39.7%). The median Acute Physiology and Chronic Health Evaluation (APACHE) score on admission to ICU was 11 (IQR 8.5-17.5). The major complications included acute respiratory distress syndrome (ARDS) 50.0%, shock 41.4%, and acute kidney injury 41.4%. The proportion of patients who underwent mechanical ventilation, required vasopressors, or were on renal replacement therapy were 58.6%, 41.4%, and 10.3%, respectively. Overall mortality was 32.8%. Age, Charlson-comorbidity index, tachypnea, lymphopenia at presentation, high APACHE score, shock, ARDS, mechanical ventilation, and steroid use were significantly associated with mortality. Of the patients who survived their ICU stay, 63.2% were discharged home and 44.7% had a new oxygen requirement at discharge.Conclusion and relevanceOur study reports high mortality in COVID-19 patients requiring ICU care in Western Pennsylvania. Identifying factors associated with poor prognosis could help risk-stratify these patients. Prospective studies are needed to assess whether early risk stratification and triaging result in improved outcomes.

COVID-19 infection among autoimmune rheumatic disease patients: Data from an observational study and literature review

The impact of SARS-CoV-2 infection in patients with autoimmune/auto-inflammatory rheumatic diseases (AARD) under immunomodulatory treatment has been a focus of interest during the COVID-19 pandemic. In this observational study, demographic data, disease related features and comorbidities, COVID-19 manifestations and outcome as well as antibody responses to SARS-CoV-2 were recorded among 77 consecutive patients with underlying AARD infected by SARS-CoV-2. Analysis of data was performed using univariate and multivariate models. Most patients (68.8%) had a mild COVID-19 course. The predominant clinical manifestations were fatigue (58.4%), low grade fever (45.4%) and upper respiratory tract symptoms (68.8%). About a quarter of patients required hospitalization (23.3%) and the mortality rate was 1.3%. Regarding COVID-19 severity, prior treatment with corticosteroids, mycophenolate mofetil or rituximab was more common in patients who developed a more serious disease course (60.0 vs 29.9%, p = 0.003, 40.0 vs 7.5%, p = 0.003, 10.0 vs 0.0%, p = 0.009, respectively). When disease related features and comorbidities were considered in multivariate models, older age and lung disease in the context of the AARD were found to be independent predictive factors for hospitalization (OR [95%]: 1.09 [1.03–1.15] and 6.43 [1.11–37.19]). Among COVID-19 related features, patients with shortness of breath and high-grade fever were more likely to get hospitalized (OR [95%]: 7.06 [1.36–36.57], 12.04 [2.96–48.86]), while anosmia was independently associated with lower hospitalization risk (OR [95%]: 0.09 [0.01–0.99]). Though the majority of AARD patients displayed a mild COVID-19 course, certain underlying disease features and COVID-19 related manifestations should prompt alertness for the physician to identify patients with AARD at high risk for severe COVID-19 and need for hospitalization.

Cytokine-Induced Modulation of SARS-CoV2 Receptor Expression in Primary Human Nasal Epithelial Cells.

Background: Viral entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) via the spike protein enables endocytosis into host cells using the ACE2 receptor and TMPRSS2. The frequent upper respiratory tract symptoms of COVID-19 and the localization of the virus to the nasopharynx, the most common site of swabbing, indicate that the sinonasal mucosa may play an important role in SARS-CoV2 infection and viral replication. Methods: This paper investigates the presence of ACE2 receptor and TMPRESS2 expression in the primary human nasal epithelial cells (HNECs) from the following: chronic rhinosinusitis without nasal polyps (CRSsNP), CRS with nasal polyps (CRSwNP) and control (non-CRS) patients, and maps the expression changes when exposed to Th1, Th2, Th17-associated cytokines. Results: We found that ACE2 and TMPRSS2 expression was higher in control HNECs than CRSwNP HNECs, and that both ACE2 and TMPRSS2 were downregulated further by Th2 cytokines in CRSwNP HNECs. Conclusions: This indicates an immune dysregulated state of CRSwNP mucosa, which normally contributes to a chronic inflammatory state, and might support an altered susceptibility to SARS-CoV2 infection and transmission.

Analysis of Ear, Nose and Throat Manifestations in COVID-19 Patients.

Introduction Coronavirus disease 2019 (COVID-19) has dramatically spread all over the world, crossing the borders of all countries. It is presented mainly by lower respiratory tract symptoms such as fever, cough, dyspnea, and chest tightness. However, COVID-19 causes different upper respiratory tract-related symptoms including nasal congestion, sore throat, and olfactory dysfunction. Objective To discuss different ear, nose and throat (ENT) manifestations in COVID-19-positive patients and their relation to other manifestations and to the severity of COVID-19. Methods We detected ENT manifestations in polymerase chain reaction (PCR)-confirmed positive COVID-19 patients at Zagazig Isolation Hospitals (Zagazig University hospitals, Zagazig Chest hospital, Al-Ahrar hospital, and Zagazig Fever hospital) with proportional allocation in the period from April 15 to June 15, 2020. All patients were subjected to full history taking and COVID-19 was categorized into 4 classes of severity after all patients underwent computed tomography (CT) of the chest. Afterwards, the collected data was analyzed and compared. Results Among the included 120 COVID-19 patients, the most frequent reported ENT manifestations were; sore throat (30%), nasal congestion (28.3%), nasal obstruction (26.7%), sneezing (26.6%), headache (25%), smell and taste dysfunction (25%), rhinorrhea (20%), upper respiratory tract infection (URTI) (15%), and tonsil enlargement (10%). The most common non-ENT manifestations were fever (88.3%), cough (63.3%), and dyspnea (45%). Conclusion Fever and cough are the dominant symptoms of COVID-19, but ENT manifestations for COVID-19 are common and should be a part of the suspected clinical criteria for COVID-19, particularly if the nasal examination was nonsignificant. The most common symptoms are sore throat, followed by nasal congestion and obstruction, headache, and lastly, olfactory dysfunction.

Experimental Antiviral Therapeutic Studies for Human Rhinovirus Infections

Rhinovirus infection is common and usually causes mild, self-limiting upper respiratory tract symptoms. Rhinoviruses can cause exacerbation of chronic respiratory diseases, such as asthma or chronic obstructive pulmonary disease, leading to a significant burden of morbidity and mortality. There has been a great deal of progress in efforts to understand the immunological basis of rhinovirus infection. However, despite a number of in vitro and in vivo attempts, there have been no effective treatments developed. This review article summarises the up to date virological and immunological understanding of these infections. We discuss the challenges researchers face, and key solutions, in their work to investigate potential therapies including in vivo rhinovirus challenge studies. Finally, we explore past and present experimental therapeutic strategies employed in the treatment of rhinovirus infections and highlight promising areas of future work.

Impact of a Missed Diagnosed COVID-19 Patient on Healthcare Workers at a Private Hospital, Bangkok, Thailand, 2020

On 23 Mar 2020, the Situation Awareness Team of the Emergency Operations Center, Department of Disease Control, was notified that a 44-year-old Thai male, who was infected with coronavirus disease 2019 (COVID-19), had died in a private hospital in Bangkok, and there was a suspicion that some healthcare workers were infected with SARS-CoV-2 following his death. A descriptive cross-sectional study was conducted. We reviewed medical records of the index case, interviewed relatives of the index case, and performed contact tracing using a standard questionnaire. We could identify 206 high-risk contacts. Twenty out of 206 high-risk contacts were then found to be infected with SARS-CoV-2. Fifteen of them were healthcare workers, two of them were current inpatients, and the other three were household contacts. The likely cause of disease spreading was the missed diagnosis of COVID-19 as the index case did not present with upper respiratory tract symptoms at the first visit to the hospital. Meal sharing among healthcare workers and sharing of a portable chest X-ray machine without proper protective equipment potentially served as other causes of COVID-19 spreading.

Leprosy suspect presenting at a chest clinic.

Leprosy is an ancient ailment, also known as Hansen's disease. It primarily involves the superficial peripheral nerves, skin, upper respiratory tract mucosa, eyes, bones and testicles, but not the lungs. Although leprosy patients are not included in the study area of pulmonology, here we present an undiagnosed leprosy patient with a history of smoking, who was referred owing to upper respiratory tract symptoms and bilateral pleural effusions. From this undiagnosed case, we would like to draw specific attention of pulmonologists, since a patient with leprosy can present in this way due to hypoalbuminemia resulting from a systemic inflammatory state, which may then progress to sepsis. Collaboration of different specialists may be required to clinch extra-neurological and extra-cutaneous features of leprosy.