COVID-19 and anosmia: A review based on up-to-date knowledge.

Dysgeusia is the first recognized oral symptom of novel coronavirus disease (COVID-19). In this review article, we described oral lesions of COVID-19 patients. We searched PubMed library and Google Scholar for published literature since December 2019 until September 2020. Finally, we selected 35 articles including case reports, case series and letters to editor. Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki-like, EM-like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa-like, angular cheilitis, atypical Sweet syndrome, and Melkerson-Rosenthal syndrome. Oral lesions were symptomatic in 68% of the cases. Oral lesions were nearly equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID-19 disease had more widespread and sever oral lesions. Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper-inflammatory response secondary to COVID-19 are the most important predisposing factors for onset of oral lesions in COVID-19 patients.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/dth.14578

Oral manifestations of COVID-19 disease: A review article.

Background: Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological, neuropsychiatric and psychological effects. This review aims to analyze them with a discussion of evolving therapeutic recommendations. Methods:
 PubMed and Google Scholar were searched from 1 January 2020 to 30 May 2020 with the following key terms: “COVID-19”, “SARS-CoV-2”, “pandemic”, “neuro-COVID”, “stroke-COVID”, “epilepsy-COVID”, “COVID-encephalopathy”, “SARS-CoV-2-encephalitis”, “SARS-CoV-2-rhabdomyolysis”, “COVID-demyelinating disease”, “neurological manifestations”, “psychosocial manifestations”, “treatment recommendations”, “COVID-19 and therapeutic changes”, “psychiatry”, “marginalised”, “telemedicine”, “mental health”, “quarantine”, “infodemic” and “social media”. A few newspaper reports related to COVID-19 and psychosocial impacts have also been added as per context. Results:
 Neurological and neuropsychiatric manifestations of COVID-19 are abundant. Clinical features of both central and peripheral nervous system involvement are evident. These have been categorically analyzed briefly with literature support. Most of the psychological effects are secondary to pandemic-associated regulatory, socioeconomic and psychosocial changes. Conclusion:
 Neurological and neuropsychiatric manifestations of this disease are only beginning to unravel. This demands a wide index of suspicion for prompt diagnosis of SARS-CoV-2 to prevent further complications and mortality.

/pdf/neurological-and-neuropsychiatric-impacts-of-covid-19-n8f06cv81y.pdf

Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic.

SARS-CoV-2 Receptors and Entry Genes Are Expressed in the Human Olfactory Neuroepithelium and Brain.

Patients with coronavirus disease 2019 (COVID-19) may have symptoms of anosmia or partial loss of the sense of smell, often accompanied by changes in taste. We report 5 cases (3 with anosmia) of adult patients with COVID-19 in whom injury to the olfactory bulbs was interpreted as microbleeding or abnormal enhancement on MR imaging. The patients had persistent headache (n = 4) or motor deficits (n = 1). This olfactory bulb injury may be the mechanism by which the Severe Acute Respiratory Syndrome coronavirus 2 causes olfactory dysfunction.

http://www.ajnr.org/content/ajnr/early/2020/06/25/ajnr.A6675.full.pdf

Anosmia in COVID-19 Associated with Injury to the Olfactory Bulbs Evident on MRI.

According to WHO recommendations, everyone must protect themselves against Coronavirus disease 2019 (COVID-19), which will also protect others. Due to the lack of current effective treatment and vaccine for COVID-19, screening, rapid diagnosis and isolation of the patients are essential (1, 2). Therefore, identifying the early symptoms of COVID-19 is of particular importance and is a health system priority. Early studies from COVID-19 outbreak in China have illustrated several non-specific signs and symptoms in infected patients, including fever, dry cough, dyspnea, myalgia, fatigue, lymphopenia, and radiographic evidence of pneumonia (3, 4). Recently, a probability of association between COVID-19 and altered olfactory function has been reported in South Korea, Iran, Italy, France, UK and the United States (5-8). However, to our knowledge, the definite association between COVID-19 and anosmia has not been published.

/pdf/anosmia-as-a-prominent-symptom-of-covid-19-infection-1ubjam5tvx.pdf

Anosmia as a prominent symptom of COVID-19 infection.

In early December 2019, the acute respiratory illness began in the Wuhan, China, which quickly spread around the world, that today known as COVID-19. (Sun, Qie, Liu, Ren, & Xi, 2020) Preliminary studies have shown that hospitalized patients have different symptoms, including myalgia, whooping cough, fatigue, and dyspnea and gastrointestinal complains. (Guo et al., 2020; Zhang et al., 2020) In more recent studies, skin manifestations have also been reported in covid-19 patients.

Oral cavity lesions as a manifestation of the novel virus (COVID-19).

Introduction: Since December 2019, novel coronavirus (COVID-19) infection has been identified as the cause of an outbreak of respiratory illness in Wuhan, China The classic presentation of COVID-19 infection was described as fever, myalgia, cough, and fatigue Whether coronavirus can directly attack the endocrine glands is unclear Objective: Post-viral subacute thyroiditis (SAT, de Quervain thyroiditis) has been reported following other viral infection A limited number of SAT after COVID-19 infection have been reported up to now Methods: Here, we reported 6 patients with SAT and positive COVID-19 serology tests Demographic, clinical, biochemical, and imaging data were presented Results: In this study, 6 patients (4 women and 2 men) with clinician manifestations and physical examination in favor of SAT were described Cervical ultrasonography showed bilateral hypoechoic areas in the thyroid gland which was suggestive of SAT Elevated C-reactive protein, erythrocyte sedimentation rate, free thyroxine, free tri-iodothyronine, and undetectable thyrotropin were found in laboratory evaluations Both IgM and IgG were positive for COVID-19 infection, but the PCR tests were negative in all patients Patients had history of working in a COVID center and/or family member hospitalized due to COVID-19 pneumonia Patients were followed up for 1 month and were treated effectively with steroids Conclusion: This report may help physicians to identify lesser-known manifestations and complications of COVID-19 Early diagnosis of COVID-19 infection results in the prevention of further transmission © 2020 European Thyroid Association Published by S Karger AG, Basel All rights reserved

/pdf/subacute-thyroiditis-in-covid-19-patients-4wkgnu4ot0.pdf

Subacute Thyroiditis in COVID-19 Patients

Background: Despite the advantages of dual peer mentoring, there are a few reports of implementing and evaluating such programs for medical students. This study aimed at exploring the perceptions of mentors and mentees about the dual peer mentoring program for the first year undergraduate medical students of Tehran University of Medical Sciences. Methods: This qualitative study was conducted at the end of the first year of implementing the mentoring program. All mentees and mentors were invited to participate in focus group discussions. Data were analyzed using a qualitative content analysis. Results: All mentors (n= 12) and a group of mentees (n= 21) participated in focus group discussion sessions. We provided a variety of supports for the mentees including academic and psychosocial support and positive relationship; as a result, some developments occurred to the mentors We also explored participants' views on some unique aspects of the program such as student-authorized, dual mentoring, and role model sessions. Conclusion: Our participants found the mentoring program beneficial in various academic achievements and psychosocial supports for both the mentors and the mentees. Dual peer mentoring program can be an alternative to school administered programs.

/pdf/dual-peer-mentoring-program-exploring-the-perceptions-of-2gnpo0sx08.pdf

Dual peer mentoring program: exploring the perceptions of mentors and mentees

Background: Smoking and unhealthy diet are two major risk factors for non-communicable diseases. The aim of this study was to investigate the possible association between these two risk factors amongst healthy adults 30-60 years old in Tehran, Iran. Methods: Overall, 2602 healthy adults 30 to 60 years old in Tehran were studied. The demographic characteristics, anthropometric and smoking status of the participants were questioned. The frequency of consumption of red meat, white meat, fruits and vegetables, dairy products, bread and cereals and fast food were questioned to be daily, weekly, monthly, once every 6 months or yearly and categorized as ―healthy‖ or ―unhealthy‖. Results: Of the 2602 participants, 974 (37.4%) had smoked more than 100 cigarettes in their life time and continued daily or smoked occasionally. Smokers significantly consumed more fast food and white meat but less fruit and vegetables and dairy product (P<0.0001). Totally, 586 (22.5%) consumed ―unhealthy‖ diet. A positive association between cigarette smoking and unhealthy diet (OR=1.68; 95% CI: 1.40-2.03) were found. After adjusting the analysis for the effect of age, education and gender, the odds ratio of consuming unhealthy diet for the smoker increased to 1.83 (1.50, 2.25) compared with non-smoker. Conclusion: Our study found a noticeable association between cigarette smoking and unhealthy diet. Smoking cessation and changing diet program for smokers is recommended.

/pdf/smoking-and-diet-in-healthy-adults-a-cross-sectional-study-1o9nxbu2me.pdf

Farrokh Heidari

Papers

Anosmia as a prominent symptom of COVID-19 infection.

Oral cavity lesions as a manifestation of the novel virus (COVID-19).

Subacute Thyroiditis in COVID-19 Patients

Dual peer mentoring program: exploring the perceptions of mentors and mentees

Smoking and Diet in Healthy Adults: A Cross-Sectional Study in Tehran, Iran, 2010