Trastornos del gusto: actualización y aproximación clínica / Taste disorders: update and clinical approach

Resumen Los trastornos del gusto constituyen un grupo de alteraciones relativamente frecuentes en la práctica clínica. Son de etiología diversa, pudiendo afectar la vía gustativa en distintos niveles, manifestándose, clínicamente, con alteraciones cuantitativas y/o cualitativas de la sensibilidad gustativa. En gran parte de los casos se puede lograr un diagnóstico etiológico con una anamnesis adecuada, examen físico y exploraciones complementarias básicas. No obstante, existe poco entendimiento de su patogénesis, así como limitadas opciones terapéuticas, lo que implica la falta de algoritmos de diagnóstico y tratamiento completamente validados. El objetivo de la presente revisión es otorgar una actualización y un abordaje práctico de los trastornos del gusto.

Abstract Taste disorders represent a group of alterations relatively frequent in clinical practice. They have a diverse etiology, and they can affect the gustatory pathway at different levels, clinically manifesting with quantitative/qualitative alterations on taste sensitivity. In most of cases it is possibly to achieve an etiologically diagnosis with appropriate anamnesis, physical exploration, and basic complementary tests. However, their pathogenesis is not well understood, and they have limited therapeutic options, which determines a lack of well-validated diagnosis and treatment algorithms. The objective of this review is to provide and update and a practical approach to taste disorders.

Subjective assessment of taste and smell disfunction in patients with COVID-19 in Paraguay / Evaluación subjetiva de las alteraciones del sentido del gusto y del olfato en pacientes con COVID-19 en Paraguay

The alteration of the senses of taste and smell in relation to COVID-19 is a widely known phenomenon; however, this alteration has not been exhaustively characterized in the international literature. The following study is proposed with the aim of describing the alterations in the senses of taste and smell in relation to COVID-19 by means of their subjective evaluation. The nature of the study is observational, descriptive and cross-sectional, and was applied to patients who sought medical attention via remote consultations carried out on virtual platforms of the Service of Otorhinolaryngology and Head and Neck Surgery of the Clínicas Hospital, San Lorenzo, between the months of March and October of 2021. We included 440 patients aged 31.3 ± 9.9 years (18 to 60 years), 308 (70%) female, 388 (88%) from urban areas, with evidence of infection by SARS-CoV-2 by RT-PCR in 260 (59%), predominantly without comorbidities 232 (53%), with fever as the most frequently reported symptom 352 (80%), treated more frequently with NSAIDs 208 (47%) and/or Paracetamol 216 (49%). Both taste and smell alterations in patients who have had COVID-19 have been shown to appear more frequently 1 to 7 days after the onset of symptoms (207 for smell, 184 for taste), occurring more frequently with a total decrease of both senses (anosmia 302 and ageusia 216), recovering completely in most cases (214 and 216) and within a period of 1 to 4 weeks (140 and 130).

La alteración de los sentidos del gusto y del olfato en relación con el COVID-19 es un fenómeno ampliamente conocido, sin embargo, esta alteración no ha sido caracterizada de forma exhaustiva en la literatura internacional. Se plantea el siguiente estudio con el objetivo de describir las alteraciones del sentido del gusto y del olfato en relación con el COVID-19 a través de la evaluación subjetiva del mismo. El mismo es observacional, descriptivo, de corte transversal, aplicado a pacientes que consultaron a través de teleconsultas realizadas sobre plataformas virtuales de la Cátedra y Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital de Clínicas, de San Lorenzo, durante los meses de marzo a octubre del 2021. Fueron incluidos 440 pacientes de 31,3 ± 9,9 años (18 a 60 años), 308 (70%) de sexo femenino, 388 (88%) provenientes de zona urbana, con evidencia de infección por SARS-CoV-2 por RT-PCR en 260 (59%), predominantemente sin comorbilidades 232 (53%), con fiebre como síntoma asociado al COVID-19 más frecuentemente reportado 352 (80%), tratados más frecuentemente con AINES 208 (47%) y/o Paracetamol 216 (49%). Tanto la alteración del gusto como del olfato en pacientes que han cursado con COVID-19 ha demostrado ser aparecer más frecuentemente en 1 a 7 días del inicio del cuadro (207 para el olfato. 184 para el gusto), cursando más frecuentemente con disminución total de ambos sentidos (anosmia 302 y ageusia 216), recuperándose más frecuentemente de forma total (214 y 216) y en un plazo de 1 a 4 semanas (140 y 130).

Correlation analysis of smell and taste loss with COVID-19 outbreak trend based on big data of internet / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the correlation between loss of smell/taste and the number of real confirmed cases of coronavirus disease 2019 (COVID-19) worldwide based on Google Trends data, and to explore the guiding role of smell/taste loss for the COVID-19 prevention and control. Methods: "Loss of smell" and "loss of taste" related keywords were searched in the Google Trends platform, the data were obtained from Jan. 1 2019 to Jul. 11 2021. The daily and newly confirmed COVID-19 case number were collected from World Health Organization (WHO) since Dec. 30 2019. All data were statistically analyzed by SPSS 23.0 software. The correlation was finally tested by Spearman correlation analysis. Results: A total of data from 80 weeks were collected. The retrospective analysis was performed on the new trend of COVID-19 confirmed cases in a total of 186 292 441 cases worldwide. Since the epidemic of COVID-19 was recorded on the WHO website, the relative searches related to loss of smell/taste in the Google Trends platform had been increasing globally. The global relative search volumes of "loss of smell" and "loss of taste" on Google Trends was 10.23±2.58 and 16.33±2.47 before the record of epidemic while 80.25±39.81 and 80.45±40.04 after (t value was 8.67, 14.43, respectively, both P<0.001). In the United States and India, the relative searches for "loss of smell" and "loss of taste" after the record of epidemic were also much higher than before (all P<0.001). The correlation coefficients between the trend of weekly new COVID-19 cases and the Google Trends of "loss of smell" in the global, United States, and India was 0.53, 0.76, and 0.82 respectively (all P<0.001), the correlation coefficients with Google Trends of "loss of taste" was 0.54, 0.78, and 0.82 respectively (all P<0.001). The lowest and highest point of loss of smell/taste search curves of Google Trends in different periods appeared 7 to 14 days earlier than that of the weekly newly COVID-19 confirmed cases curves, respectively. Conclusions: There is a significant positive correlation between the number of newly confirmed cases of COVID-19 worldwide and the amount of keywords, such as "loss of smell" and "loss of taste", retrieved in Google Trends. The trend of big data based on Google Trends might predict the outbreak trend of COVID-19 in advance.

Prevalencia de trastornos del gusto en niños y adolescentes con infección por coronavirus: revisión sistemática / Prevalence of taste disorders in children and adolescents with coronavirus infection: a systematic review

Objetivo: Determinar la prevalencia de trastornos del gusto en pacientes niños y adolescentes diagnosticados con infección por coronavirus, a través de la evidencia en la literatura científica. Materiales y métodos: Una revisión sistemática de los artículos publicados entre el 19 de diciembre del 2019 y el 20 de diciembre del 2020 en las bases de datos Medline, Lilacs, BVS, Cochrane, SCOPUS y ScienceDirect. La estrategia de búsqueda de información se basó en el diagrama de flujo clásico de PRISMA. Para la evaluación del riesgo de sesgo, se usó la escala Newcastle-Ottawa. Resultados: Se encontraron 443 artículos en seis bases de datos y se incluyó un total de 7 artículos después de la evaluación, según los criterios de selección. Los artículos abordaron la variable de trastornos del gusto en tres formas: ageusia, disgeusia e hipogeusia, y se halló que esta manifestación clínica estaba presente desde los inicios de la infección. Conclusiones: Se ha encontrado una prevalencia de trastornos del gusto en niños y adolescentes diagnosticados con infección por coronavirus desde un 3,3% hasta un 26,9%. (AU)

Aim: To assess the prevalence of taste disorders in children and adolescents diagnosed with coronavirus infection according to the evidence reported in the scientific literature. Materials and Methods: A systematic review of articles published between December 19, 2019, and December 20, 2020 in the Medline, Lilacs, BVS, Cochrane, SCOPUS and ScienceDirect databases. The information search strategy was based on the classic PRISMA flow diagram. The Newcastle-Ottawa scale was used to assess the risk of bias. Results: 443 articles were found in six databases, and a total of 7 articles were included after evaluation according to the selection criteria. The articles addressed the variable of taste disorders in three ways: ageusia, dysgeusia and hypogeusia; finding that this clinical manifestation was present from the beginning of the infection. Conclusions: The prevalence of taste disorders in children and adolescents diagnosed with coronavirus infection is from 3.3% to 26.9%. (AU)

Disfunciones quimiosensoriales del olfato y el gusto provocadas por el SARS-CoV-2 / Chemosensory dysfunctions of taste and smell caused by SARS-CoV-2 / Disfunções quimiossensoriais de olfato e paladar causadas pelo SARS-CoV-2

RESUMEN Introducción: Múltiples reportes de la literatura científica avalan, que los trastornos del olfato y el gusto son cada vez más frecuentes desde el inicio de la COVID-19, ofreciendo diversos mecanismos fisiopatológicos para explicar estas alteraciones. Objetivo: Sistematizar las evidencias científicas disponibles, relacionadas con alteraciones del olfato y gusto producidas por SARS-CoV-2. Método: Se desarrolló una revisión bibliográfica basada en el análisis documental, la sistematización y contrastación de la información científica realizada sobre el tema. Las búsquedas se realizaron en bases de datos disponibles (SciELO, Medline, Scopus, Medscape), con el buscador Google Académico. Desarrollo: La información se estructuró en aspectos morfofuncionales de los sistemas del olfato y el gusto; estructura y replicación del SARS-CoV-2; interacción del virus con el sistema renina-angiotensina-aldosterona, su afinidad por el receptor enzima convertidora; mecanismos fisiopatológicos de estas disfunciones. Conclusiones: Aunque se describen las alteraciones del olfato y el gusto en pacientes con COVID-19, no están totalmente esclarecidos los mecanismos fisiopatogénicos relacionados con estas disfunciones quimiosensoriales. No obstante, su aparición en ausencia de otras enfermedades respiratorias, debe alertar al personal de salud sobre la posibilidad de infección por SARS-CoV-2.

ABSTRACT Introduction: Multiple scientific reports certified that disorders of taste and smell are more frequent since COVID-19 onset, reporting various pathophysiological mechanisms to explain these alterations. Objective: To methodize the available scientific evidence related to smell and taste disorders caused by SARS-CoV-2. Method: A bibliographic review, based on the documentary analyses, systematization and contrasting view of scientific information on the topic, was carried out. Search was conducted on available databases (SciELO, Medline, Scopus, Medscape), using the web search engine Academic Google. Development: Information gathered was performed based on taste and smell morphofunctional aspects; structure and replication of SARS-CoV-2; virus interaction with renin-angiotensin-aldosterone system and its affinity for the converting enzyme receptor; pathophysiological mechanisms of these dysfunctions. Conclusions: Although alterations of smell and taste are described in patients with COVID-19, the pathophysiological mechanisms associated with these chemosensory dysfunctions are not totally clarified. However, the onset of these symptoms in absence of other respiratory illnesses should alert health care personnel concerning to a possible SARS-CoV-2 infection.

RESUMO Introdução: Diversos relatos da literatura científica sustentam que os distúrbios do olfato e do paladar são cada vez mais frequentes desde o início da COVID-19, oferecendo vários mecanismos fisiopatológicos para explicar essas alterações. Objetivo: Sistematizar as evidências científicas disponíveis relacionadas às alterações de olfato e paladar produzidas pelo SARS-CoV-2. Método: Foi desenvolvida uma revisão bibliográfica a partir da análise documental, da sistematização e do contraste das informações científicas realizadas sobre o assunto. As buscas foram realizadas nas bases de dados disponíveis (SciELO, Medline, Scopus, Medscape), com a ferramenta de busca Google Scholar. Desenvolvimento: A informação foi estruturada em aspectos morfofuncionais dos sistemas olfativo e gustativo; estrutura e replicação de SARS-CoV-2; interação do vírus com o sistema renina-angiotensina-aldosterona, sua afinidade pelo receptor enzima conversora; mecanismos fisiopatológicos dessas disfunções. Conclusões: Embora as alterações do olfato e do paladar sejam descritas em pacientes com COVID-19, os mecanismos fisiopatogênicos relacionados a essas disfunções quimiossensoriais não estão totalmente esclarecidos. No entanto, seu aparecimento na ausência de outras doenças respiratórias deve alertar o pessoal de saúde para a possibilidade de infecção pelo SARS-CoV-2.

Symptomatic manifestations of the disease caused by coronavirus (COVID-19) in adults: systematic review / Manifestaciones sintomáticas de la enfermedad causada por coronavirus (COVID-19) en adultos: revisión sistemática / Manifestações sintomáticas da doença causada por coronavírus (COVID-19) em adultos: revisão sistemática

ABSTRACT Objective To identify symptoms of COVID-19 in adults in the scientific literature. Method Systematic review of studies published from December 1, 2019 to April 21, 2020 from the Scopus, Web of Science and PubMed databases, in order to answer the following research question: "What are the symptoms caused by COVID-19 in adults?" using the keywords "Symptoms", "Clinical Manifestations", "Coronavirus", "COVID-19". Results Of the total 105 references, 13 references that addressed the symptoms of COVID-19 were selected. Fever and normal or dry cough were symptoms present in all studies. Conclusion The symptoms identified in adult patients were fever, normal or dry cough, headache, pharyngalgia, dyspnea, diarrhea, myalgia, vomiting, sputum or expectoration, anxiety or chest pain, fatigue, nausea, anorexia, abdominal pain, rhinorrhea, runny nose or nasal congestion, dizziness, chills, systemic pain, mental confusion, hemoptysis, asthma, taste disorder, smell disorder, belching and tachycardia.

RESUMEN Objetivo Verificar en la literatura científica las manifestaciones sintomáticas de COVID-19 en adultos. Método Una revisión sistemática realizada en las bases de datos Scopus, Web of Science y PubMed con estudios publicados del 1 de diciembre de 2019 al 21 de abril de 2020, con el fin de responder a la pregunta orientadora: "¿Cuáles son las manifestaciones sintomáticas causada por COVID-19 en adultos?" utilizando las palabras clave: "Síntomas", "Manifestaciones clínicas", "Coronavirus", "COVID-19". Resultados Del total de 105 referencias, se seleccionaron 13 que abordaron las manifestaciones sintomáticas de COVID-19, con fiebre y tos normal o seca presente en todos los estudios. Conclusión Las manifestaciones sintomáticas identificadas en pacientes adultos fueron: fiebre, tos normal o seca, dolor de cabeza, faringalgia, disnea, diarrea, mialgia, vómitos, esputo o expectoración, angustia o dolor en el pecho, fatiga, náuseas, anorexia, dolor abdominal, rinorrea, secreción nasal o congestión nasal, mareos, escalofríos, dolor sistémico, confusión mental, hemoptisis, asma, alteración del gusto, alteración del olfato, eructos y taquicardia.

RESUMO Objetivo Verificar na literatura científica as manifestações sintomáticas da COVID-19 em pessoas adultas. Método Revisão sistemática utilizando as bases Scopus, Web of Science e PubMed com estudos publicados de 1 de dezembro de 2019 a 21 de abril de 2020, a fim de responder à questão norteadora: "Quais as manifestações sintomáticas causada pela COVID-19 em pessoas adultas?" utilizando-se as palavras-chave: "Symptoms", "Clinical Manifestations", "Coronavirus", "COVID-19". Resultados Do total de 105 referências, foram selecionadas 13 que abordaram as manifestações sintomáticas da COVID-19, estando a febre e a tosse normal ou seca presente em todos os estudos. Conclusão As manifestações sintomáticas identificadas nos pacientes adultos foram: febre, tosse normal ou seca, cefaleia, faringalgia, dispneia, diarreia, mialgia, vômito, escarro ou expectoração, angústia ou dor no peito, fadiga, náusea, anorexia, dor abdominal, rinorreia, coriza ou congestão nasal, tontura, calafrios, dor sistêmica, confusão mental, hemoptise, asma, comprometimento do paladar, comprometimento do olfato, arroto e taquicardia.

Disfunción olfativa y gustativa en pacientes con COVID-19 de Argentina / Olfactory and gustatory disfunction in COVID-19 patients from Argentin

INTRODUCCIÓN: Existen evidencias sobre el deterioro del olfato y el gusto en pacientes con la enfermedad por el nuevo coronavirus (COVID-19). Se hallaron diferencias en la proporción de pacientes afectados por estos síntomas en distintas poblaciones. Con base en el patrón de presentación, a partir de abril de 2020, la definición de caso sospechoso en Argentina incorporó la pérdida parcial o total de olfato o de gusto. El objetivo de este estudio fue evaluar la proporción de pacientes con COVID-19 que presentan pérdida de olfato o de gusto en Argentina. MÉTODOS: Estudio multicéntrico. Participaron pacientes con COVID-19 mayores de 18 años confirmados con reacción en cadena de la polimerasa en tiempo real (RT-PCR, por sus siglas en inglés) en muestras obtenidas por hisopado entre el 15 de mayo y el 31 de agosto de 2020. Los participantes completaron una encuesta en línea, que incluyó preguntas sociodemográficas sobre síntomas de COVID-19, comorbilidades y la percepción de la pérdida del olfato y el gusto. RESULTADOS: Participaron 241 pacientes, 79% informaron pérdida de olfato y 54%, de gusto. En 32% de los casos, la pérdida de olfato fue el primer síntoma. La proporción de hombres y mujeres que informaron pérdida olfativa fue similar y lo mismo ocurrió en relación con la pérdida de gusto. Tampoco se observaron diferencias en relación con la edad. DISCUSIÓN: Una proporción elevada de pacientes con COVID-19 presenta disfunción olfativa y gustativa en la población argentina. Resulta importante la disponibilidad amplia de un test para la evaluación del olfato y el gusto con adaptación sociocultural y que pueda realizarse en el hogar. En el futuro, se implementará la realización de un test masivo desechable y digital

Manifestaciones clínicas y complicaciones de la Enfermedad por Coronavirus 2019 (COVID-19): revisión de la literatura / Clinical manifestations and complications of Coronavirus Disease 2019 (COVID-19)

La Enfermedad por Coronavirus 2019 (COVID-19) supone un reto sin precedentes para la salud pública. Los médicos deben fortalecer sus habilidades clínicas para combatir esta nueva enfermedad. El objetivo de esta revisión fue describir los signos, síntomas y complicaciones de pacientes con COVID-19. Se realizó una búsqueda en la literatura en la base de datos PubMed incluyendo publicaciones entre 1 de diciembre 2019 y 15 de agosto 2020, sin restricciones de lenguaje, utilizando las palabras clave 'COVID-19' cruzada con 'manifestaciones clínicas', 'signos y síntomas' y 'complicaciones'. Se incluyeron revisiones sistemáticas y meta-análisis, estudios epidemiológicos y series de casos. Se identificaron 1,066 artículos, de los cuales se seleccionaron 71 de acuerdo a los contenidos previamente definidos por los autores. La COVID-19 presenta un curso de leve a moderado y severo-crítico, específicamente en mayores de 65 años con o sin comorbilidades. Los signos y síntomas no son específicos y usualmente se superponen de acuerdo a la edad y a la fase de la enfermedad. Los síntomas más comunes son fiebre, tos y fatiga. Síntomas menos comunes incluyen escalofríos, dolor de garganta, cefalea, mialgias/artralgias, pérdida del gusto y del olfato, diarrea, nausea, vómitos, congestión nasal, palpitaciones, opresión precordial y dolor pleurítico. La sintomatología en niños difiere de la de los adultos y el curso es usualmente benigno y de baja mortalidad. La evaluación clínica de COVID-19 supone un reto hoy en día. Sin embargo, el conocimiento de la historia natural de la enfermedad permite situar los síntomas comunes e inespecíficos en el contexto clínico correcto.

Coronavirus disease 2019 (COVID-19) presents an unprecedented challenge to public health. Physicians must strengthen clinical skills for this new disease. This review aimed to describe the signs, symptoms and complications of patients with COVID-19. A literature search was conducted in the PubMed database, including publications between December 1, 2019, to August 15, 2020, without language restrictions, using the keywords 'COVID-19' crossed with 'clinical manifestations', 'signs and symptoms', and 'complications'. Systematic reviews, meta-analysis, epidemiological studies, and case report series were included. A total of 1,066 articles were identi¬fied, among 71 were selected according to the contents previously defined by the authors. COVID-19 has a mild to moderate or severe-critical course, specifically in over 65 years of age, with or without comorbidities. Signs and symptoms are not specific and usually overlap according to the age and stage of the disease. The most common symptoms are fever, cough, and fatigue. Less common symptoms include chills, sore throat, headache, myalgia/ arthralgia, loss of taste and smell, diarrhea, nausea, vomiting, nasal congestion, palpitations, chest tightness, and pleuritic pain. The symptomatology in children differs from that of adults, and the course is usually benign and low mortality. Clinical evaluation of COVID-19 is challenging today. However, knowledge of the disease's natural history allows placing common and nonspecific symptoms in the correct clinical context.

Síntomas atípicos en enfermedad por COVID-19: reporte de caso / Atypical symptoms in COVID-19 disease: case report

The infection caused by the SARS-CoV-2 virus, recently described in Wuhan, China, has put numerous health systems around the world in check. Given its high contagiousness and the exponential growth of cases, it was declared a pandemic by the world health organization. Although the majority of those infected will present mild symptoms, a smaller percentage will present severe manifestations of the disease, such as acute respiratory distress syndrome, requiring ventilator support measures and stays in intensive care units. The main symptoms described in SARS-CoV-2 infection are fever, fatigue, dry cough and myalgia. Despite this, there is a not insignificant number of patients who present with atypical symptoms of the disease, some described are anosmia, ageusia, gastrointestinal symptoms like diarrhea, dermatological manifestations, among others. In these patients it is particularly where the diagnosis is made late, delaying isolation and prevention measures, thus increasing the risk of contagion within the population.

Neurological complications in patients with SARS-CoV-2 infection: a systematic review / Complicações neurológicas em pacientes infectados pelo SARS-CoV-2: uma revisão sistemática

ABSTRACT Background: As the COVID-19 pandemic unfolds worldwide, different forms of reports have described its neurologic manifestations. Objective: To review the literature on neurological complications of SARS-CoV-2 infection. Methods: Literature search performed following systematic reviews guidelines, using specific keywords based on the COVID-19 neurological complications described up to May 10th, 2020. Results: A total of 43 articles were selected, including data ranging from common, non-specific symptoms, such as hyposmia and myalgia, to more complex and life-threatening conditions, such as cerebrovascular diseases, encephalopathies, and Guillain-Barré syndrome. Conclusion: Recognition of neurological manifestations of SARS-CoV-2 should be emphasized despite the obvious challenges faced by clinicians caring for critical patients who are often sedated and presenting other concurrent systemic complications.

RESUMO Introdução: À medida que a pandemia da COVID-19 se desenvolve em todo o mundo, diferentes tipos de publicações descreveram suas manifestações neurológicas. Objetivo: Revisar a literatura sobre complicações neurológicas da infecção por SARS-CoV-2. Métodos: A pesquisa bibliográfica foi realizada seguindo diretrizes de revisões sistemáticas, usando palavras-chave específicas baseadas nas complicações neurológicas da COVID-19 descritas até 10 de maio de 2020. Resultados: Foram selecionados 43 artigos, incluindo descrições que variam de sintomas comuns e inespecíficos, como hiposmia e mialgia, a condições mais complexas e com risco de vida, como doenças cerebrovasculares, encefalopatias e síndrome de Guillain-Barré. Conclusão: O reconhecimento das manifestações neurológicas da SARS-CoV-2 deve ser enfatizado apesar dos óbvios desafios enfrentados pelos clínicos que cuidam de pacientes críticos, muitas vezes sedados e apresentando outras complicações sistêmicas concomitantes.

Avaliação da percepção sensorial ao gosto doce em pessoas com Diabetes Mellitus tipo 2 / Evaluation of the sensory perception of sweet taste in people with Diabetes Mellitus type 2

Avaliar a percepção sensorial de pacientes com Diabetes Mellitus tipo 2, por meio do teste de índicelimiar para o gosto doce. Métodos: estudo transversal, composto por 80 adultos de ambos os sexos, divididosem dois grupos: controle, composto por não diabéticos, e teste, formado por pacientes diabéticos. Avaliação dapercepção sensorial realizada pelo teste de sensibilidade para determinação do índice limiar. Testes conduzidosem cinco sessões, contendo as concentrações diferentes de sacarose. Análise estatística por meio do teste t,adotado p˂0,05. Resultados: ao comparar a média dos limiares para detecção do gosto doce entre diabéticos enão diabéticos foi notório que os diabéticos são menos sensíveis ao estímulo doce. Conclusão: indivíduos comDiabetes Mellitus 2 apresentam valor de índice limiar maior para o gosto doce, o que pode contribuir para oaumento do consumo de açúcar.

Objective: to evaluate the perception of patients with type 2 diabetes through the threshold index test for the sweet taste. Methods: a cross-sectional study with 80 adults of both genders, divided into two groups: control, composed of non-diabetics, and test, with diabetic patients. The evaluation of sensory perception held by the sensitivity test to determine the threshold index. The tests were conducted on five sections containing different concentrations of sucrose. Statistical analysis was held using the t test, adopted P<0.05. Results: when comparing the average of the thresholds to detect sweet taste between diabetics and non-diabetics, it was known that diabetics are less sensitive to sweet stimuli. Conclusion: individuals with Diabetes Mellitus 2 have higher threshold index value for the sweet taste, which may contribute to the increase in sugar consumption.

Ageusia in the Patients with Myasthenia Gravis

No abstract available.

A Case of Cronkhite-Canada Syndrome Showing Spontaneous Remission

Cronkhite-Canada syndrome (CCS) is a rare, noninherited gastrointestinal polyposis syndrome associated with ectodermal changes such as alopecia, nail dystrophy, and cutaneous hyperpigmentation. The etiology and pathogenesis of CCS are not known, but diarrhea, malnutrition, gastrointestinal bleeding, and infection may occur in the affected patient; moreover, this condition could be fatal. However, previous reports have described several cases of spontaneous remission. We report a 60-year-old man who was incidentally found to have colonic polyposis, alopecia, and hypogeusia and was diagnosed to have CCS. However, this patient experienced spontaneous remission, including regrowth of body hair and alleviation of bowel inflammation, without any specific medications such as steroids, antibiotics, or proton pump inhibitors.

Terbinafine-induced taste impairment - report of two cases

Terbinafine is an oral antimycotic agent that belongs to the allylamine class. It was introduced in 1991 and is being widely used, both topically and systemically, to treat fungal infections. Nowadays oral terbinafine has become a commonly prescribed drug to treat finger- and toenail fungal infections because of relatively short duration of treatment compared to other oral antifungals like griseofulvin and fluconazole. The common side effects of this drug include nausea, abdominal pain, elevated transaminases and allergic reactions. Loss of taste sensation is a rare side effect occurring in patient taking oral form of this drug. PubMed search showed that very few cases of terbinafineinduced taste loss have been reported worldwide. We report a case series of two patients who complained of taste loss after taking terbinafine

Clinical examination of olfactory and gustatory function / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore changes of olfactory and gustatory functions in patients with olfactory dysfunction.@*METHOD@#The 284 study subjects included 92 healthy volunteers, 92 with hyposmia and 100 with functional anosmia. Their olfactory and gustatory functions were examined using T&T olfactometer, olfactory event-related potentials (OERPs) and triple drop method, respectively.@*RESULT@#The T&T results showed that the difference between patients with hyposmia and functional anosmia and healthy subjects had statistical significance. The OERPs results showed that patients with olfactory dysfunction had N1 and P2 waves of prolonged latency and reduced amplitude when compared to healthy subjects with the difference of statistical significance. When compared to healthy subjects, patients with olfactory dysfunction had clear hypogeusia and the difference had statistical significance. There was no significant difference between female and male groups.@*CONCLUSION@#It is suggested that the apparently concomitant hypogeusia is in patients with olfactory dysfunction. Decreased of olfactory and gustatory function exhibited little or no relationship with gender. Combined examinations of OERPs, T&T and triple drop method, could make it possible to reflect the overall chemical sensory functions in subjects systematically and provide scientific evidence for clinical diagnosis and treatment early.

Repercussões da radioterapia na região orofacial e seu tratamento / Impact of radiotherapy on the orofacial region and management of related conditions

A radioterapia em região de cabeça e pescoço provoca inúmeras sequelas ao paciente irradiado, afetando o sistema estomatognático e com repercussões sistêmicas importantes. As sequelas da radiação ionizante podem ser extensas e, algumas vezes, permanentes, em especial nas glândulas salivares e no tecido ósseo. É relevante que o cirurgião dentista tenha conhecimento das reações adversas e das formas adequadas de prevenção e tratamento para amenizar o desconforto e melhorar a condição de vida do paciente irradiado. Portanto, a conscientização e motivação deste paciente, com a promoção de saúde oral através da adequação do meio bucal e orientações sobre ações preventivas, são essenciais para se obter o melhor prognóstico.

Head and neck radiotherapy causes countless sequelae in irradiated patients, affecting the stomatognathic system, with significant systemic implications. Sequelae of exposure to ionizing radiation may be extensive and sometimes permanent, particularly in the salivary glands and bone tissue. It is of utmost importance that the surgeon dentist be aware of adverse reactions and appropriate forms of treatment to alleviate discomfort and improve the quality of life of the irradiated patient. Therefore, awareness and motivation of the patient, with promotion of oral health through the adaptation of the oral environment and guidance on preventive measures are essential to get a better prognosis.

Efeito da radiação ionizante sobre o paladar em pacientes submetidos a radioterapia para a região da cabeça e pescoço / Effect of ionizing radiation on the taste function of patients submitted to head and neck radiotherapy

OBJETIVO: Avaliar os efeitos da radiação ionizante sobre o paladar, em pacientes que foram submetidos a radioterapia na região de cabeça e pescoço. MATERIAIS E MÉTODOS: Foram selecionados 20 pacientes que possuíam diagnóstico de tumor na região de cabeça e pescoço, que iniciaram tratamento no Setor de Radioterapia da Santa Casa de Misericórdia de Belo Horizonte, MG, Brasil. Para testes do paladar, foram manipuladas quatro soluções (salgada - NaCl; doce - sacarose; azeda - ácido cítrico; amarga - ureia) em três concentrações diferentes (fraca, média e forte), administradas por meio de conta-gotas, três gotas de cada solução de maneira aleatória, respeitando a ordem das concentrações fracas, médias e fortes. Após a aplicação de cada solução, o paciente relatava o sabor que sentia. O procedimento foi realizado semanalmente durante as três primeiras semanas de radioterapia. RESULTADOS: Foi observada diferença estatisticamente significante na perda do paladar dos pacientes em tratamento radioterápico, quando se compararam a 1ª e 4ª semanas de tratamento na solução salgada, nas três concentrações, na solução doce nas concentrações fracas e médias e nas soluções azedas e amargas, apenas quando se testaram as concentrações fracas. CONCLUSÃO: A radiação ionizante altera o paladar de pacientes submetidos a radioterapia de cabeça e pescoço.

OBJECTIVE: To evaluate the effects of ionizing radiation on the taste function in patients submitted to radiotherapy in the head and neck region. MATERIALS AND METHODS: Twenty patients diagnosed with head and neck tumors and undergoing treatment in the Division of Radiotherapy at Santa Casa de Misericórdia de Belo Horizonte, MG, Brazil, were selected. For their taste function testing, four solutions were manipulated with salt (NaCl), sugar (sucrose), citric acid (for acidity), and urea (for bitterness), at three different (low, medium and high) concentrations. Weekly tests were performed during the first three weeks of radiotherapy, with random administration of the solutions (three drops each) respecting the order of their concentration levels (low, medium and high). After the application of each solution, the patient reported which flavor he/she tasted. RESULTS: A statistically significant difference was observed in the loss of taste function as the results in the 1st and 4th weeks of treatment were compared, with salty solution at the three concentration levels, with the sweet solution at low and medium concentrations, and with the sour and bitter solutions, only at low concentration. CONCLUSION: Ionizing radiation alters the taste function of patients submitted to head and neck radiotherapy.