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Journal of the Association of Medical... Jan 2024Delays in COVID-19 testing may increase the risk of secondary household and community transmission. Little is known about what patient characteristics and symptom...
BACKGROUND
Delays in COVID-19 testing may increase the risk of secondary household and community transmission. Little is known about what patient characteristics and symptom profiles are associated with delays in test seeking.
METHODS
We conducted a retrospective cohort study of all symptomatic patients diagnosed with COVID-19 and assessed in a COVID Expansion to Outpatients (COVIDEO) virtual care program between March 2020 and June 2021. The primary outcome was later test seeking more than 3 days from symptom onset. Multivariable logistic regression was used to examine predictors of later testing including patient characteristics and symptoms (30 individual symptoms or 7 symptom clusters).
RESULTS
Of 5,363 COVIDEO patients, 4,607 were eligible and 2,155/4,607 (46.8%) underwent later testing. Older age was associated with increased odds of late testing (adjusted odds ratio [aOR] 1.007/year; 95% CI 1.00 to 1.01), as was history of recent travel (aOR 1.4; 95% CI 1.01 to 1.95). Health care workers had lower odds of late testing (aOR 0.50; 95% CI 0.39 to 0.62). Late testing was associated with symptoms in the cardiorespiratory (aOR 1.2; 95% CI 1.05, 1.36), gastrointestinal (aOR = 1.2; 95% CI 1.04, 1.4), neurological (aOR 1.1; 95% CI 1.003, 1.3) and psychiatric (aOR 1.3; 95% CI 1.1, 1.5) symptom clusters. Among individual symptoms, dyspnea, anosmia, dysgeusia, sputum, and anorexia were associated with late testing; pharyngitis, myalgia, and headache were associated with early testing.
CONCLUSION
Certain patient characteristics and symptoms are associated with later testing, and warrant further efforts to encourage earlier testing to minimize transmission.
PubMed: 38250614
DOI: 10.3138/jammi-2023-0007 -
PloS One 2024Alzheimer's disease (AD) is a complex neurodegenerative disorder with both genetic and non-genetic causes. Animal research models are available for a multitude of...
Alzheimer's disease (AD) is a complex neurodegenerative disorder with both genetic and non-genetic causes. Animal research models are available for a multitude of diseases and conditions affecting the central nervous system (CNS), and large-scale CNS gene expression data exist for many of these. Although there are several models specifically for AD, each recapitulates different aspects of the human disease. In this study we evaluate over 500 animal models to identify those with CNS gene expression patterns matching human AD datasets. Approaches included a hypergeometric based scoring system that rewards congruent gene expression patterns but penalizes discordant gene expression patterns. The top two models identified were APP/PS1 transgenic mice expressing mutant APP and PSEN1, and mice carrying a GFAP mutation that is causative of Alexander disease, a primary disorder of astrocytes in the CNS. The APP/PS1 and GFAP models both matched over 500 genes moving in the same direction as in human AD, and both had elevated GFAP expression and were highly congruent with one another. Also scoring highly were the 5XFAD model (with five mutations in APP and PSEN1) and mice carrying CK-p25, APP, and MAPT mutations. Animals with the APOE3 and 4 mutations combined with traumatic brain injury ranked highly. Bulbectomized rats scored high, suggesting anosmia could be causative of AD-like gene expression. Other matching models included the SOD1G93A strain and knockouts for SNORD116 (Prader-Willi mutation), GRID2, INSM1, XBP1, and CSTB. Many top models demonstrated increased expression of GFAP, and results were similar across multiple human AD datasets. Heatmap and Uniform Manifold Approximation Plot results were consistent with hypergeometric ranking. Finally, some gene manipulation models, including for TYROBP and ATG7, were identified with reversed AD patterns, suggesting possible neuroprotective effects. This study provides insight for the pathobiology of AD and the potential utility of available animal models.
Topics: Animals; Humans; Mice; Rats; Alzheimer Disease; Amyloid beta-Peptides; Amyloid beta-Protein Precursor; Disease Models, Animal; Gene Expression; Mice, Transgenic; Mutation; Presenilin-1; Repressor Proteins
PubMed: 38236817
DOI: 10.1371/journal.pone.0291995 -
Saudi Medical Journal Jan 2024To develop a reliable version of the Saudi Arabian-University of Pennsylvania smell identification test (SA-UPSIT) and to establish normative values for both genders.
OBJECTIVES
To develop a reliable version of the Saudi Arabian-University of Pennsylvania smell identification test (SA-UPSIT) and to establish normative values for both genders.
METHODS
This cross-sectional study was carried out on voluntarily recruited normal participants in King Saud University Medical City, Riyadh, Saudi Arabia, from April 2018 to May 2023. Culture-familiar odors were chosen and the kit was translated into Arabic for the study. The test was modified 3 times in 4 versions. Following this, a random sample was collected to carry out a re-test after 6 weeks.
RESULTS
A total of 288 subjects participated in the development of the SA-UPSIT across all versions, including 146 females and 142 males. The average age of the participants was 28.4±9.9 years. In the final version, 111 participants scored an average of 34.5±2.5 for the total score, 35±2.3 for females, and 34.1±2.6 for males. The test-retest reliability coefficient was 0.73, indicating acceptable reliability.
CONCLUSION
The new changes carried out to the SA-UPSIT increased the average scores and demonstrated good reliability, making it clinically applicable for diagnosing and monitoring olfactory dysfunction.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Smell; Saudi Arabia; Olfaction Disorders; Cross-Cultural Comparison; Cross-Sectional Studies; Reproducibility of Results
PubMed: 38220245
DOI: 10.15537/smj.2024.45.1.20230422 -
Virology Journal Jan 2024Previous meta-analyses estimating the prevalence of the post-COVID-19 condition (PCC) were confounded by the lack of negative control groups. This may result in an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous meta-analyses estimating the prevalence of the post-COVID-19 condition (PCC) were confounded by the lack of negative control groups. This may result in an overestimation of the prevalence of those experiencing PCC, as these symptoms are non-specific and common in the general population. In this study, we aimed to compare the burden of persistent symptoms among COVID-19 survivors relative to COVID-19-negative controls.
METHODS
A systematic literature search was conducted using the following databases (PubMed, Web of Science, and Scopus) until July 2023 for comparative studies that examined the prevalence of persistent symptoms in COVID-19 survivors. Given that many of the symptoms among COVID-19 survivors overlap with post-hospitalization syndrome and post-intensive care syndrome, we included studies that compare the prevalence of persistent symptoms in hospitalized COVID-19 patients relative to non-COVID-19 hospitalized patients and in non-hospitalized COVID-19 patients relative to healthy controls that reported outcomes after at least 3 months since infection. The results of the meta-analysis were reported as odds ratios with a 95% confidence interval based on the random effects model.
RESULTS
Twenty articles were included in this study. Our analysis of symptomatology in non-hospitalized COVID-19 patients compared to negative controls revealed that the majority of symptoms examined were not related to COVID-19 infection and appeared equally prevalent in both cohorts. However, non-COVID-19 hospitalized patients had higher odds of occurrence of certain symptoms like anosmia, ageusia, fatigue, dyspnea, and brain fog (P < 0.05). Particularly, anosmia and ageusia showed substantially elevated odds relative to the negative control group at 11.27 and 9.76, respectively, P < 0.05. In contrast, analysis of hospitalized COVID-19 patients compared to those hospitalized for other indications did not demonstrate significantly higher odds for the tested symptoms.
CONCLUSIONS
The persistent symptoms in COVID-19 survivors may result from hospitalization for causes unrelated to COVID-19 and are commonly reported among the general population. Although certain symptoms exhibited higher odds in non-hospitalized COVID-19 patients relative to controls, these symptoms are common post-viral illnesses. Therefore, the persistent symptoms after COVID-19 may not be unique to SARS-CoV-2. Future studies including well-matched control groups when investigating persistent symptoms in COVID-19 survivors are warranted to draw a firm conclusion.
Topics: Adult; Child; Humans; Ageusia; Anosmia; COVID-19; Post-Acute COVID-19 Syndrome
PubMed: 38212781
DOI: 10.1186/s12985-024-02284-3 -
Medical Principles and Practice :... 2024The aim of the study is to determine the prevalence and factors associated with olfactory dysfunction in individuals with COVID-19 in the first 2 years of the pandemic...
OBJECTIVE
The aim of the study is to determine the prevalence and factors associated with olfactory dysfunction in individuals with COVID-19 in the first 2 years of the pandemic in Brazil.
MATERIALS AND METHODS
This is a prevalent study involving the confirmed cases of COVID-19 recorded in the municipality between the years 2020 and 2021. Individuals symptomatic for COVID-19, with a positive laboratory result and aged 12 or older were included in this study. Measures of central tendency and dispersion were used in the description of continuous variables and frequency was used for categorical variables. The Shapiro-Wilk test was used to evaluate data distribution.
RESULTS
Data from 20,669 individuals were analyzed. The prevalence of olfactory disorders was 17.9% and increased from 11.5% to 21.9% between 2020 and 2021. A female gender predominance was observed among individuals who reported anosmia, with 61.1% (n = 564) in 2020 and 61.7% (n = 1,713) in 2021. On the other hand, the median age of individuals with olfactory disorders was lower than that of the group without disorders (35 [IQR 27-46] vs. 39 [IQR 29-50]; p < 0.001). Smell disturbances were present in 18.2% (n = 3,634) of patients who recovered and in 7.1% (n = 38) of those who died. Furthermore, in 2021, a prevalence rate of 30.6% for olfactory disorders was linked to obesity as a comorbidity.
CONCLUSION
The prevalence of olfactory disorders was lower compared to other studies, with cough and fever being negatively related to olfactory dysfunction and headache, coryza, and taste disorders being positively related. Obesity was the only associated comorbidity.
PubMed: 38198785
DOI: 10.1159/000536191 -
PloS One 2024Objective olfactory function can be assessed using validated olfactory tests like the Sniffin' Sticks Test (SST). However, their extensive nature makes them less...
Objective olfactory function can be assessed using validated olfactory tests like the Sniffin' Sticks Test (SST). However, their extensive nature makes them less suitable for clinical practice. To address this, shorter olfactory tests like the screenings Sniffin' Sticks Test (SST-12) can be used for screening purposes and reduce testing time. The SST-12 serves as a diagnostic tool for screening olfaction in cases unrelated to COVID-19. However, these screening tests are uncertain regarding their accuracy in detecting olfactory dysfunction in patients with COVID-19 as the plausible cause. We aim to determine the diagnostic accuracy of the SST-12 in adults with post-COVID-19 olfactory dysfunction. We performed a diagnostic accuracy study with data from 113 consecutive COVID-19 diagnosed patients who experienced objectified smell loss ever since. At approximately 6 months after their diagnosis, all participants underwent the SST (reference standard), part of the SST was the SST-12 (index test). Diagnostic accuracy of the SST-12 is measured as negative predictive value (NPV), positive predictive value (PPV), sensitivity, and specificity. The SST-12 detected smell loss in 85 patients among 91 patients with smell loss and ruled out smell loss in 15 patients among the 22 patients without smell loss based on the reference standard. Making sensitivity 93.4% (CI 0.87-0.97), and specificity 68.2% (CI 0.48-0.85). Out of the 92 patients with a positive test result on SST-12, 85 patients had indeed smell loss (PPV 92.4% CI 0.86-0.97), and out of the 21 patients with a negative test result, 15 patients had no smell loss regarding the reference standard (NPV 71.4% CI 0.50-0.88). The findings suggest that the SST-12 holds promise as a useful tool for identifying individuals with smell loss, also in individuals with COVID-19 as cause, but it is important to have a good understanding of the interpretation of the results of the SST-12 when considering its implementation in clinical practice.
Topics: Adult; Humans; Anosmia; COVID-19; Olfaction Disorders; Smell; Reference Standards; COVID-19 Testing
PubMed: 38198490
DOI: 10.1371/journal.pone.0295911 -
Microbiology Spectrum Feb 2024The partial or complete loss of the sense of smell, which affects about 20% of the population, impairs the quality of life in many ways. Dysosmia and anosmia are mainly...
The partial or complete loss of the sense of smell, which affects about 20% of the population, impairs the quality of life in many ways. Dysosmia and anosmia are mainly caused by aging, trauma, infections, or even neurodegenerative disease. Recently, the olfactory area-a site containing the olfactory receptor cells responsible for odor perception-was shown to harbor a complex microbiome that reflects the state of olfactory function. This initially observed correlation between microbiome composition and olfactory performance needed to be confirmed using a larger study cohort and additional analyses. A total of 120 participants (middle-aged, no neurodegenerative disease) were enrolled in the study to further analyze the microbial role in human olfactory function. Olfactory performance was assessed using the Sniffin' Stick battery, and participants were grouped accordingly (normosmia: = 93, dysosmia: = 27). The olfactory microbiome was analyzed by 16S rRNA gene amplicon sequencing and supplemented by metatranscriptomics in a subset (Nose 2.0). Propidium monoazide (PMA) treatment was performed to distinguish between intact and non-intact microbiome components. The gastrointestinal microbiome of these participants was also characterized by amplicon sequencing and metabolomics and then correlated with food intake. Our results confirm that normosmics and dysosmics indeed possess a distinguishable olfactory microbiome. Alpha diversity (i.e., richness) was significantly increased in dysosmics, reflected by an increase in the number of specific taxa (e.g., , , and ). Lower olfactory performance was associated with microbial signatures from the oral cavity and periodontitis (, , and ). However, PMA treatment revealed a higher accumulation of dead microbial material in dysosmic subjects. The gastrointestinal microbiome partially overlapped with the nasal microbiome but did not show substantial variation with respect to olfactory performance, although the diet of dysosmic individuals was shifted toward a higher meat intake. Dysosmia is associated with a higher burden of dead microbial material in the olfactory area, indicating an impaired clearance mechanism. As the microbial community of dysosmics (hyposmics and anosmics) appears to be influenced by the oral microbiome, further studies should investigate the microbial oral-nasal interplay in individuals with partial or complete olfactory loss.IMPORTANCEThe loss of the sense of smell is an incisive event that is becoming increasingly common in today's world due to infections such as COVID-19. Although this loss usually recovers a few weeks after infection, in some cases, it becomes permanent-why is yet to be answered. Since this condition often represents a psychological burden in the long term, there is a need for therapeutic approaches. However, treatment options are limited or even not existing. Understanding the role of the microbiome in the impairment of olfaction may enable the prediction of olfactory disorders and/or could serve as a possible target for therapeutic interventions.
Topics: Middle Aged; Humans; Smell; Anosmia; Quality of Life; RNA, Ribosomal, 16S; Neurodegenerative Diseases; Olfaction Disorders
PubMed: 38193689
DOI: 10.1128/spectrum.01549-23 -
BMC Geriatrics Jan 2024Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We... (Observational Study)
Observational Study
BACKGROUND
Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia.
METHODS
This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events.
RESULTS
Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups.
CONCLUSION
Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.
Topics: Humans; Aged; Brazil; Cohort Studies; COVID-19; SARS-CoV-2; Inpatients; Sepsis; Dementia
PubMed: 38182982
DOI: 10.1186/s12877-023-04494-w -
The Medical Journal of Malaysia Dec 2023This study aimed to determine the prevalence and association between the severity of COVID-19 and short and long-term neuropsychiatric symptoms, as well as the risk... (Observational Study)
Observational Study
INTRODUCTION
This study aimed to determine the prevalence and association between the severity of COVID-19 and short and long-term neuropsychiatric symptoms, as well as the risk factors for the development of these symptoms.
MATERIALS AND METHODS
A prospective observational study was conducted between 1st October 2021 till September 2022 in the state of Johor, Malaysia. 300 patients with confirmed SARS-CoV-2 infection were randomly selected and followed up for six months. Data were analysed by using Chi-square test, Fisher's Exact test, Paired t test and Multiple logistic regression.
RESULTS
The prevalence of short-term neuropsychiatric symptoms was 78%, with anosmia being the most prevalent symptom. Long-term symptoms were found in 22.75% of patients, with headache being the most prevalent (p= 0.001). COVID-19 Stage 2 and 3 infections were associated with a higher risk of short-term neuropsychiatric symptoms, OR for Stage 2 infection was 5.18 (95% CI: 1.48-16.97; p=0.009) and for Stage 3 infection was 4.52 (95% CI: 1.76-11.59; p=0.002). Complete vaccination was a significant predictor of longterm symptoms with adjusted OR 3.65 (95% CI 1.22-10.91; p=0.021).
CONCLUSION
This study demonstrated that neuropsychiatric symptoms were common among COVID-19 patients in Johor, Malaysia and the risk of these symptoms was associated with the severity of the infection. Additionally, complete vaccination does not completely protect against long-term neuropsychiatric deficits. This is crucial for continuous monitoring and addressing neuropsychiatric symptoms in COVID-19 survivors.
Topics: Humans; Anosmia; COVID-19; Inpatients; Malaysia; SARS-CoV-2; Prospective Studies
PubMed: 38159927
DOI: No ID Found -
International Journal of Pediatric... Jan 2024Extensive olfactory testing is sparsely applied in pediatric patients in clinical routine especially because of its time taking nature. Therefore a 5-item odor...
OBJECTIVES
Extensive olfactory testing is sparsely applied in pediatric patients in clinical routine especially because of its time taking nature. Therefore a 5-item odor identification test (quick "U-Sniff", "qU-Sniff") from the 12-item "U-Sniff" test was developed.
METHODS
A total of 724 normosmic children between 6 and 17 years of age, divided in four age groups, were included in this retrospective study. Additionally, 17 children with congenital anosmia in the same age range were included. To calculate test-retest reliability 90 participants from the healthy group were tested twice.
RESULTS
The five most correctly identified odors from the 12-item "U-Sniff" test were: coffee (98 %), peach (95 %), flower (90 %), fish (88 %) and onion (84 %). Normosmic participants scored 4.71 ± 0.62 points on the "qU-Sniff" test. A significant correlation between results of the 12-item and 5-item test (n = 724; r = 0.580; p < 0.001) and a significant test-retest reliability (r = 0.626, p < 0.001) were shown. For "qU-Sniff" validation a ROC analysis to distinguish between anosmic patients and healthy controls was conducted for each age group separately. AUCs were as followed: i) 0.963 ± 0.018, p < 0,001; ii) 0.978 ± 0.013, p < 0.001; iii) 0.992 ± 0.006, p < 0.001; iv) 0.994 ± 0.005, p < 0.001. The cut-off value to determine anosmic and normosmic participants was <4 points.
CONCLUSION
With the "qU-Sniff" test, we present a short screening tool for clinical routine with <4 points as cut-off to initiate more detailed olfactory testing.
Topics: Humans; Child; Retrospective Studies; Reproducibility of Results; Smell; Olfaction Disorders; Odorants
PubMed: 38157707
DOI: 10.1016/j.ijporl.2023.111834