Impact of COVID-19 and post-infectious course on the olfactory function: "Restitutio ad integrum" or permanent deficit?

The experience of our center with patients who, after having overcome the SARS-CoV19 infection, manifested olfactory disorders includes 1952 patients who were evaluated, according to the protocol established in multidisciplinary agreement with internal medicine and infectious disease specialists, through ENT physical examinatio, questionnaires, olfactometry and gustometry (before and after treatment). Our goal was to evaluate: the prevalence of smell and taste disorders in patients affected by SARSCoV19, the resolution of the mentioned disorder based on the treatment protocols and eventually a possible correlation with patients not affected by the SARS-CoV19 infection. Our evaluation method included: Chemosensory Complaint Score, three VAS scales for olfactory and gustatory dysfunction and nasal obstruction symptoms, full ENT evaluation (rhinoscopy, oropharyngoscopy, evaluation of larynx and tympanic membranes). In the context of the DH PostCovid, an olfactory deficit was observed in 24.3% of cases; the questionnaire submitted to the patients during the acute phase of the infection tended to overestimate the incidence of the symptoms, but this data is likely related to the psychological impact of the disease itself during the early stages of the pandemic. In a period ranging from 2 to 9 months (M 5.5 months), we found a subjective and olfactometrically detected recovery of the olfactory function in almost all patients (98.6%); in only one case the recovery was obtained 13 months after the first evaluation. Among these patients, 65% of them regained the olfactory function during the first 3 months of therapy. Our therapy protocol consisted of: either topical use of glyceritic acid plus mannitol for topical use in case of inflamed nasal mucosa or crosslinked ialuronic acid for topical use in case of atrophic rhinitis together with citicoline 1000mg per os and olfactory rehabilitation. Once having obtained these data, and keeping in mind that the therapy was personalized and modulated on the basis of the conditions found at the physical evaluation for each patient (presence or absence of significant nasal dryness, allergic rhinitis, etc.), and although the "unpredictability" of this pandemic imposes a certain caution on us, we can affirm that it is not frequent, in our series of cases, the persistence of the olfactory deficit in patients with previous SARS-CoV19 infection and that indeed the restitutio ad integrum is the most frequent of the eventualities

Stress ossidativo nei pazienti con diagnosi di sindrome delle apnee ostruttive notturne

La Sindrome delle Apnee Ostruttive Notturne (OSAS) è una patologia caratterizzata da alterazioni metaboliche e da un elevato rischio di sviluppo di patologie cardiovascolari. Lo scopo dello studio è stato quello di identificare dei markers precoci predittivi di rischio cardiovascolare con la valutazione dello stress ossidativo misurato attraverso esami di laboratorio in soggetti normali e pazienti con diagnosi di sindrome delle apnee ostruttive notturne. È stato effettuato uno studio prospettico per confrontare i risultati di laboratorio ottenuti dalla valutazione dei biomarkers dello stress ossidativo in 20 pazienti adulti con OSAS e 20 soggetti sani. Le tecniche di analisi utilizzate avevano l’obiettivo di identificare e quantificare i danni dei radicali liberi attraverso la misurazione di anti-ossidanti e pro-ossidanti in modo da valutare l’equilibrio ossidativo presente nei due gruppi di studio. I due gruppi di pazienti sono risultati omogeni per sesso, età ed indice di massa corporea (p < 0,05). Una differenza statisticamente significativa è stata individuata tra i livelli di indice di apnea-ipopnea valutata alla polisonnografia e di isoprostani, produzione di proteine di ossidazione e proteine non legate al ferro nei due gruppi in esame. Nessuna differenza significativa è stata trovata nel livello dei tioli tra i soggetti sani e i pazienti con sindrome delle apnee ostruttive. I tioli, a differenza degli altri markers, sono molecole anti-ossidanti, i restanti sono invece espressione di danno ossidativo. I risultati dello studio indicano che i biomarkers potrebbero essere utilizzati come indici di ostruzione delle vie aeree superiori (VAS) e come marcatori precoci di ipossiemia causando processi flogistici ricorrenti e danno locale da radicali liberi a carico delle VAS

Multidisciplinary management of anemia behind epistaxis in HHT

HHT affects one in 5000 people and occurs in all the ethnic groups and areas. It is also known as the Rendu-Osler-Weber disease and it is an inherited autosomal dominant genetic disorder, characterized by vascular abnormalities. Epistaxis, specifically recurrent and spontaneous nosebleeds, has been assessed as one of the most common, if not the most common clinical manifestation in HHT patients. The burden related to this manifestation has both psychological and physical consequences, especially since the treatment options follow a ladder that might bring to surgery and more invasive therapies. The EQ-VAS questionnaire allows us to adequately assess and classify HHT patients based on the intensity and type of epistaxis-related symptoms. This same questionnaire, which is submitted to patients during each evaluation for the benefit of anamnestic supplementation, includes both a question about the presence or absence of anemia and one about whether a red cell transfusion has been performed in the past months or since the last outpatient visit. As a matter of fact, chronic nosebleed, although mild to moderate, can lead to anemia within months or years and, in general, to a poor quality of life. Patients who have to undergo iron supplementation treatments often face the almost inevitable side effects that this therapy entails (diarrhea, constipation, nausea, persistent metallic taste, abdominal pain, etc.). Although numerous treatment options are available for patients with epistaxis phenotype, from topical to surgical, we believe, based on the successes achieved in the follow up of HHT patients at our center, that a multidisciplinary collaboration is essential to identify the patients who can benefit most from each treatment

Nasal lavage CCL24 levels correlate with eosinophils trafficking and symptoms in chronic sino-nasal eosinophilic inflammation

OBJECTIVES: The aim of our study was to measure CCL24 (eotaxin-2) levels in nasal lavage fluid of patients with different forms of sinonasal chronic eosinophilic inflammation to verify the relationship with nasal hypereosinophilia and symptoms. METHODS: Patients with nasal hypereosinophilia were randomly recruited and grouped in persistent allergic rhinitis, non-allergic rhinitis with eosinophilia syndrome (NARES) and chronic rhinosinusitis with polyps. Non rhinitic volunteers were recruited as controls. CCL24 concentration was measured by `Quantikine Human CCL24 Immunoassay`. Differential cell counts were performed by microscopic cytological examination of nasal tissue scraped by inferior turbinate. RESULTS: CCL24 levels measured in patient groups were significantly higher compared to control group with the highest levels in NARES patients. Eotaxin- 2 levels were significantly correlated to severity of symptoms and to the percentage of eosinophils in nasal tissue. CONCLUSIONS: We revealed high levels of CCL24 in all patient groups showing a significant correlation with the degree of eosinophilia and clinical symptoms. A prolonged accumulation of CCL24 inside the nasal mucosa may sustain the process of unspecific self-perpetuating eosinophil recruitment pathognomonic of these patients

Salivary biomarkers and proteomics: future diagnostic and clinical utilities

Lo studio della proteomica salivare, test economico e non invasivo, rappresenta una fonte di numerose informazioni, ed è utile per la diagnosi di svariate malattie. Da quando siamo entrati nellera della tecnologia genomica e delle scienze omiche, la raccolta di campioni salivari è aumentata esponenzialmente. Recenti piattaforme proteomiche hanno analizzato il proteoma salivare umano, caratterizzando circa 3000 peptidi e proteine, espressi in maniera differente: più del 90% in peso deriva dalla secrezione delle tre ghiandole salivari maggiori, mentre la restante parte proviene dalle ghiandole salivari minori, dal fluido crevicolare gengivale, da essudati mucosi e dalla microflora orale. Lobiettivo principale dellanalisi proteomica è discriminare tra condizioni fisiologiche e patologiche. Ad oggi, tuttavia, non esiste un preciso protocollo che permetta di analizzare lintero proteoma salivare, pertanto sono state realizzate svariate strategie. Innanzitutto, è possibile distinguere due tipologie di piattaforme proteomiche: lapproccio top-down prevede lanalisi delle proteine sotto esame come entità intatte; nellapproccio bottom-up la caratterizzazione della proteina avviene mediante lo studio dei peptidi ottenuti dopo digestione enzimatica (con tripsina tipicamente). A causa di questa eterogeneità, per una stessa patologia sono stati proposti differenti biomarkers. Il proteoma salivare è stato caratterizzato in numerose malattie: carcinoma squamoso e leucoplachie orali, malattia del trapianto contro lospite (GVHD) cronica, sindrome di Sjögren e altri disordini autoimmuni come la sindrome SAPHO (sinovite, acne, pustolosi, iperostosi e osteite), schizofrenia e disordine bipolare, malattie genetiche come la sindrome di Down o la malattia di Wilson. In conclusione, i risultati delle ricerche riportate in questa review suggeriscono che nel prossimo futuro la saliva diverrà un fluido di indubbia rilevanza diagnostica utile per fini clinici, sia diagnostici, sia prognostici

Sodium enoxaparin treatment of sensorineural hearing loss: an immune-mediated response?

The authors propose the existence of a new entity of autoimmune sensorineural hearing loss on the basis of diagnostic study and treatment experience with a series of 30 patients. Immunological mechanisms play an important role in the pathogenesis and natural course of various inner-ear diseases. Patients may present clinically with symptoms resembling Ménière's disease or even with sudden deafness. Currently, no widely used standard protocol for treatment of this autoimmune sensorineural hearing loss exists. Prompted by such observations, we implemented a protocol using a particular kind of heparin - sodium enoxaparin-with a low molecular weight. Patients were randomly assigned to two groups; to those in the first group, enoxaparin was administered subcutaneously at a dose of 2,000 IU twice daily for 10 days; the patients in the second group were treated with placebo. At the beginning and at the end of the therapy period, the patients were evaluated by instrumental examinations. Specifically excluded were patients with abnormal known coagulation. On discharge, all patients treated with enoxaparin presented both a subjective and objective decrease in symptoms. No patient experienced side effects from this treatment. The results indicate that administration of sodium enoxaparin abates sensorineural hearing loss in patients with autoimmune diseases. The clinical response to therapy can confirm diagnosis

Impact of COVID-19 and post-infectious course on the olfactory function: "Restitutio ad integrum" or permanent deficit?

The experience of our center with patients who, after having overcome the SARS-CoV19 infection, manifested olfactory disorders includes 1952 patients who were evaluated, according to the protocol established in multidisciplinary agreement with internal medicine and infectious disease specialists, through ENT physical examinatio, questionnaires, olfactometry and gustometry (before and after treatment). Our goal was to evaluate: the prevalence of smell and taste disorders in patients affected by SARSCoV19, the resolution of the mentioned disorder based on the treatment protocols and eventually a possible correlation with patients not affected by the SARS-CoV19 infection. Our evaluation method included: Chemosensory Complaint Score, three VAS scales for olfactory and gustatory dysfunction and nasal obstruction symptoms, full ENT evaluation (rhinoscopy, oropharyngoscopy, evaluation of larynx and tympanic membranes). In the context of the DH PostCovid, an olfactory deficit was observed in 24.3% of cases; the questionnaire submitted to the patients during the acute phase of the infection tended to overestimate the incidence of the symptoms, but this data is likely related to the psychological impact of the disease itself during the early stages of the pandemic. In a period ranging from 2 to 9 months (M 5.5 months), we found a subjective and olfactometrically detected recovery of the olfactory function in almost all patients (98.6%); in only one case the recovery was obtained 13 months after the first evaluation. Among these patients, 65% of them regained the olfactory function during the first 3 months of therapy. Our therapy protocol consisted of: either topical use of glyceritic acid plus mannitol for topical use in case of inflamed nasal mucosa or crosslinked ialuronic acid for topical use in case of atrophic rhinitis together with citicoline 1000mg per os and olfactory rehabilitation. Once having obtained these data, and keeping in mind that the therapy was personalized and modulated on the basis of the conditions found at the physical evaluation for each patient (presence or absence of significant nasal dryness, allergic rhinitis, etc.), and although the "unpredictability" of this pandemic imposes a certain caution on us, we can affirm that it is not frequent, in our series of cases, the persistence of the olfactory deficit in patients with previous SARS-CoV19 infection and that indeed the restitutio ad integrum is the most frequent of the eventualities