Communities and local governments across the country face a period of extreme uncertainty Whether or not COVID-19 is quickly contained, changes in consumer dem

/pdf/comparative-genetic-analysis-of-the-novel-coronavirus-2019-5550ov6rkh.pdf

Comparative genetic analysis of the novel coronavirus (2019-nCoV/SARS-CoV-2) receptor ACE2 in different populations

I. Executive summary BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. Methods ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. Conclusion This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Since the initial reports of coronavirus disease 2019 (COVID-19) in China in late 2019, infections from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have spread rapidly, resulting in a global pandemic that has caused millions of deaths. Initially, the large number of infected people required the direction of global healthcare resources to provide supportive care for the acutely ill population in an attempt to reduce mortality. While clinical trials for safe and effective antiviral agents are ongoing, and vaccine development programs are being accelerated, long-term sequelae of SARS-CoV-2 infection have become increasingly recognized and concerning. Although the upper and lower respiratory tracts are the main sites of entry of SARS-CoV-2 into the body, resulting in COVID-19 pneumonia as the most common presentation, acute lung damage may be followed by pulmonary fibrosis and chronic impairment of lung function, with impaired quality of life. Also, increasing reports have shown that SARS-CoV-2 infection involves the central nervous system (CNS) and the peripheral nervous system (PNS) and directly or indirectly damages neurons, leading to long-term neurological sequelae. This review aims to provide an update on the mechanisms involved in the development of the long-term sequelae of SARS-CoV-2 infection in the 3 main areas of lung injury, neuronal injury, and neurodegenerative diseases, including Alzheimer disease, Parkinson disease, and multiple sclerosis, and highlights the need for patient monitoring following the acute stage of infection with SARS-CoV-2 to provide a rationale for the prevention, diagnosis, and management of these potential long-term sequelae.

Long-Term Respiratory and Neurological Sequelae of COVID-19.

In recent months it has emerged that the novel coronavirus-responsible for the COVID-19 pandemic-causes reduction of smell and taste in a large fraction of patients. The chemosensory deficits are often the earliest, and sometimes the only signs in otherwise asymptomatic carriers of the SARS-CoV-2 virus. The reasons for the surprisingly early and specific chemosensory dysfunction in COVID-19 are now beginning to be elucidated. In this hypothesis review, we discuss implications of the recent finding that the prevalence of smell and taste dysfunction in COVID-19 patients differs between populations, possibly because of differences in the spike protein of different virus strains or because of differences in the host proteins that enable virus entry, thus modifying infectivity. We review recent progress in defining underlying cellular and molecular mechanisms of the virus-induced anosmia, with a focus on the emerging crucial role of sustentacular cells in the olfactory epithelium. We critically examine the current evidence whether and how the SARS-CoV-2 virus can follow a route from the olfactory epithelium in the nose to the brain to achieve brain infection, and we discuss the prospects for using the smell and taste dysfunctions seen in COVID-19 as an early and rapid diagnostic screening tool.

https://journals.sagepub.com/doi/pdf/10.1177/1073858420956905

Anosmia in COVID-19: Underlying Mechanisms and Assessment of an Olfactory Route to Brain Infection.

Anosmia is one of the most prevalent symptoms of SARS-CoV-2 infection during the COVID-19 pandemic However, the cellular mechanism behind the sudden loss of smell has not yet been investigated The initial step of odour detection takes place in the pseudostratified olfactory epithelium (OE) mainly composed of olfactory sensory neurons surrounded by supporting cells known as sustentacular cells The olfactory neurons project their axons to the olfactory bulb in the central nervous system offering a potential pathway for pathogens to enter the central nervous system by bypassing the blood brain barrier In the present study, we explored the impact of SARS-CoV-2 infection on the olfactory system in golden Syrian hamsters We observed massive damage of the OE as early as 2 days post nasal instillation of SARS-CoV-2, resulting in a major loss of cilia necessary for odour detection These damages were associated with infection of a large proportion of sustentacular cells but not of olfactory neurons, and we did not detect any presence of the virus in the olfactory bulbs We observed massive infiltration of immune cells in the OE and lamina propria of infected animals, which may contribute to the desquamation of the OE The OE was partially restored 14 days post infection Anosmia observed in COVID-19 patient is therefore likely to be linked to a massive and fast desquamation of the OE following sustentacular cells infection with SARS-CoV-2 and subsequent recruitment of immune cells in the OE and lamina propria

Massive transient damage of the olfactory epithelium associated with infection of sustentacular cells by SARS-CoV-2 in golden Syrian hamsters.

Background As reported by increasing literature, a significant number of patients with SARS-CoV-2 infection developed smell/taste disorders. Aim of this study is to determine the prevalence and severity of these symptoms among laboratory-confirmed SARS-CoV-2 patients. Secondary objective is to determine their onset/recovery time. Methods This cross-sectional study was conducted from March 10 to 30, 2020 at Novara University Hospital during the COVID-19 Italian outbreak. The 355 enrolled patients answered a questionnaire at 14th (or more) days after proven infection. Results The overall population prevalence of both smell/taste or one of the two disorders was 70%. They were first symptoms in 31 (8,7%) patients. Most patients reported a complete loss that in half of the cases (49.5%) was fully recovered after 14 days, with a median recovery time of 10 days. Conclusion This study confirms a high prevalence of smell/taste disorders in COVID-19 infection with self-recovery for half cases after about 2 weeks.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/hed.26288

Smell and taste disorders during COVID-19 outbreak: Cross-sectional study on 355 patients.

Endoscopic approach represents a valid alternative to conventional septoplasty. The aim of this study is to analyze the objective and subjective data on 276 patients, who underwent traditional (147) or endoscopic (129) septoplasty. This is a prospective observational study on 276 consecutive patients affected by deviated nasal septum (DNS), who underwent isolated septoplasty between 2011 and 2018. 147 of them were treated using an “open” approach, while 129 were treated with an endoscopic approach. The two groups were compared 3 months after surgery: the objective results (complications such as bleeding, hematoma, pain, synechiae, septal tears and incomplete correction), objective (rhinomanometric data) and subjective measurements (NOSE questionnaires). Both techniques are effective in decreasing nasal obstruction and discharge. Complications such as pain, synechiae, early postoperative bleeding, septal tears and incomplete correction are less frequent in the endoscopic group (p < 0.05). The rhinomanometric analysis reveal improvement in both groups without statistical differences. Subjective questionnaires show a good symptoms relief with an improved quality of life in all 276 patients without statistical difference between the two gropus. Both techniques are effective in reducing nasal obstruction and related symptoms with fewer overall complications in the endoscopic approach. The endoscope provides improved field of view, less mucosal damages and a more anatomic dissection. Finally, such approach can be a valuable teaching tool for assistants, residents and students.

Endoscopic versus conventional septoplasty: objective/subjective data on 276 patients

Lymphangiomas are relatively uncommon head and neck region lymphatic malformations. Although surgery can be still considered the mainstay of treatment, sclerotherapy by OK-432 is becoming a widespread treatment option. The aim of this article is to present and discuss the management and outcomes of a series of cases of lymphangiomas. All patients with lymphangiomas who were treated from 2010 to 2018 were reviewed. The following data were recorded: age, gender, subtype, staging, type of treatment, outcome, and recurrence. Fifteen patients (9 females, 6 males) were included with 2 microcystic and 13 macrocystic lymphangiomas. Six patients underwent surgery with excision (5 with a complete success, one with a fair success), whereas the remaining 9 subjects underwent sclerotherapy by OK-432 (6 with a complete success, 3 with a fair success). No postoperative complications were observed. All modes of treatment are important in properly selected patients affected by lymphangiomas. OK-432 therapy is a safe and effective option in the treatment of head and neck lymphangiomas.

A single-center experience in the management of head and neck lymphangiomas

The current novel coronavirus-19 disease (COVID-19) outbreak in Italy has caused a massive increase in the use of personal protective equipment by health-care workers, including tight-fitting NP95 respirator. An otherwise healthy 35-year-old male intensivist seeked ENT attention following a 6-hour shift in the isolated COVID-19 unit. He had been wearing a NP95 face respirator nonstop for several hours over the previous 7 days. He noticed a painful swollen red area around the point of contact between the mask and the nose. Physical examination (Figure 1) confirmed he was suffering from red skin with initial abrasion, stage II nasal pressure injuries (NPIs). Many other colleagues followed (Figure 2). According to National Pressure Ulcer Staging System, these NPIs appeared at stage II in the reported case and at stage I in other collected cases (Figure 2). The discomfort developed after the first hour, but at the end of the shift, the skin of the back of the nose appears red, painful, and accompanied by pain on palpation and sometimes requires treatment with antidecubitus ointments. The injury can be painful and occurs as a result of the intense and prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear, similarly to already known decubitus, are also affected by microclimate, nutrition, perfusion, comorbidities, and condition of the soft tissue. NP95 respirators require complete adherence, causing continuous pressure with/without shear on the nasal back that slightly increases during inspiration. Nasal skin, thin and delicate, is at risk of NPI especially in case of a prominent nasal bone. Worsening of NPI can create discomfort in using such device, discourage its use, or even decrease its performance, affecting the operator’s safety, occurring in a severe situation that is already causing stress, anxiety, and fear. Prevention (frequent skin check, hydrogel foam application) and treatment are mandatory. Applying silicone or hydrogel foam cover between the mask and the skin or protecting the skin under the mask with padded bandage made with gauze, containing sodium chloride and hyaluronic acid, may be useful, but prospective study or IPD test must confirm fitness guarantee. Associated with the use of this protection, it is essential to systematically control the contact points between the skin and the rigid parts of the mask, with rigorous follow-up (skin check every 3-4 hours).

https://journals.sagepub.com/doi/pdf/10.1177/0145561320922705

Nasal Pressure Injuries During the COVID-19 Epidemic.

An emerging body of research is revealing the microbiota pivotal involvement in determining the health or disease state of several human niches, and that of vitamin D also in extra-skeletal regions. Nevertheless, much of the oral microbiota and vitamin D reciprocal impact in oropharyngeal squamous cell carcinogenesis (OPSCC) is still mostly unknown. On this premise, starting from an in-depth scientific bibliographic analysis, this narrative literature review aims to show a detailed view of the state of the art on their contribution in the pathogenesis of this cancer type. Significant differences in the oral microbiota species quantity and quality have been detected in OPSCC-affected patients; in particular, mainly high-risk human papillomaviruses (HR-HPVs), Fusobacterium nucleatum, Porphyromonas gingivalis, Pseudomonas aeruginosa, and Candida spp. seem to be highly represented. Vitamin D prevents and fights infections promoted by the above identified pathogens, thus confirming its homeostatic function on the microbiota balance. However, its antimicrobial and antitumoral actions, well-described for the gut, have not been fully documented for the oropharynx yet. Deeper investigations of the mechanisms that link vitamin D levels, oral microbial diversity and inflammatory processes will lead to a better definition of OPSCC risk factors for the optimization of specific prevention and treatment strategies.

Valeria Dell’Era

Papers

Smell and taste disorders during COVID-19 outbreak: Cross-sectional study on 355 patients.

Endoscopic versus conventional septoplasty: objective/subjective data on 276 patients

A single-center experience in the management of head and neck lymphangiomas

Nasal Pressure Injuries During the COVID-19 Epidemic.

Oral microbiota and vitamin D impact on oropharyngeal squamous cell carcinogenesis: a narrative literature review.