The long-term loss of smell and taste in Covid-19 patients ­ a systematic review and meta-analysis / A perda de olfato e paladar a longo prazo em pacientes com Covid-19 ­ uma revisão sistemática e meta-análise

INTRODUCTION: Olfactory symptoms have been reported as particular in COVID-19 patients. OBJECTIVE: To synthesize and analyze the existing evidence on the monitoring loss of sense of smell and taste in COVID-19 patients, and for how long symptoms persist after the virus is no longer active in the organism. METHODS: A search was implemented in PubMed, Embase, Scopus, Science Direct, and Web of Science databases. This systematic review and meta-analysis were conducted according to PRISMA, and the risk of bias was assessed through the Newcastle-Ottawa Scale. The review protocol is registered in PROSPERO. RESULTS: Our systematic review included data from 14 articles with a total of 2143 participants. The most reported sensory symptom of COVID-19 was anosmia, which was detected in 1499 patients, being the only symptom to appear in all studies. Ageusia was detected in 595 patients, dysgeusia in 514 patients, and hyposmia in 209 patients. The studies provided the number of 729 patients with sensory symptoms during the acute COVID-19 infection of 15 days, and 1020 patients with lasting sensory symptoms, presenting sensory dysfunctions after the average latent period of 15 days of the acute COVID-19 infection. CONCLUSION: Evidence points to the loss or dysfunction of taste and smell as one of the symptoms of COVID-19 persisting for an average time of 15 days, with 44% of COVID-19 patients with persistent symptoms for more than 15 days. Nevertheless, most studies do not perform a follow-up with those patients. Therefore, further research on sensory symptoms and their follow-up is required.

INTRODUÇÃO: Sintomas olfativos foram relatados como específicos em pacientes com COVID-19. OBJETIVO: Sintetizar e analisar as evidências existentes sobre o monitoramento da perda de olfato e paladar em pacientes com COVID-19 e por quanto tempo os sintomas persistem. MÉTODOS: Foi realizada uma busca nas bases de dados PubMed, Embase, Scopus, Science Direct e Web of Science. Esta revisão sistemática e metanálise foi realizada de acordo com o PRISMA, e o risco de viés foi avaliado por meio da Escala de Newcastle-Ottawa. O protocolo de revisão está registrado no PROSPERO. RESULTADOS: Nossa revisão sistemática incluiu dados de 14 artigos com um total de 2143 participantes. O sintoma sensorial mais comumente relatado de COVID-19 foi anosmia, detectado em 1.499 pacientes, sendo o único sintoma a aparecer em todos os estudos. Ageusia foi detectada em 595 pacientes, disgeusia em 514 pacientes e hiposmia em 209 pacientes. Os estudos forneceram o número de 729 pacientes com sintomas sensoriais por 15 dias durante a infecção aguda por COVID-19 e 1020 pacientes com sintomas sensoriais duradouros, apresentando disfunções sensoriais após o período latente médio de 15 dias da infecção aguda por COVID-19. CONCLUSÃO: Evidências apontam a perda ou disfunção do paladar e olfato como um dos sintomas da COVID-19 persistindo por um tempo médio de 15 dias, com 44% dos pacientes com COVID-19 com sintomas persistentes por mais de 15 dias. No entanto, a maioria dos estudos não realiza acompanhamento desses pacientes. Portanto, mais pesquisas sobre sintomas sensoriais e seu acompanhamento são necessárias.

Manifestaciones orales del COVID-19 en Paraguay: resultados de una encuesta en línea

Introducción: Estudios previos han reportado que pacientes infectados con el virus del COVID-19, podrían manifestar sintomatologías a nivel de la cavidad oral. Objetivo: Evaluar la frecuencia de manifestaciones orales asociadas a COVID-19 en un segmento de la población paraguaya y determinar cuáles son las más prevalentes. Metodología: Estudio descriptivo de corte transversal. Fue realizada una encuesta electrónica de enero a marzo del 2022. Los datos fueron presentados como frecuencias y porcentajes y analizados mediante la prueba de chi-cuadrado. El análisis estadístico se realizó con el software R versión 4.0.3. Resultados: La muestra estuvo compuesta por 478 personas. El 79,50 % correspondió al sexo femenino y el 45,19 % tenía entre 25 y 34 años. El 65,48 % informó haber experimentado al menos 1 síntoma o signo oral durante el curso de COVID-19. La pérdida de la sensación de sabores amargos, seguida de la alteración del sabor de los alimentos y la pérdida de la percepción dulce, fueron los síntomas más comunes. Se encontró una proporción significativamente mayor de manifestaciones orales en el rango de 18-24 años (χ²; p= 0,003). Entre las personas que desarrollaron COVID-19 de forma moderada a severa hubo mayor número de manifestaciones de síntomas orales (χ²; p= 0,044). Discusión: Se identificó una alta frecuencia de manifestaciones orales en pacientes con casos de moderados a severos de COVID-19, destacándose los trastornos del gusto como los más predominantes. Los individuos más jóvenes fueron los más afectados.

Introduction: Previous studies have reported that patients infected with the COVID-19 virus could manifest symptoms in the oral cavity. Objective: To evaluate the frequency of oral manifestations associated with COVID-19 in a segment of the Paraguayan population and determine the most prevalent ones. Methods: Descriptive cross-sectional study. An electronic survey was conducted from January to March 2022. The data were presented as frequencies and percentages and analyzed using the chi-square test. Statistical analysis was performed with R software version 4.0.3. Results: The sample consisted of 478 individuals. 79.50% were female, and 45.19% were between 25 and 34 years old. 65.48% reported having experienced at least 1 oral symptom or sign during the course of COVID-19. The loss of the sensation of bitter tastes, followed by the alteration of the taste of foods and the loss of sweetness perception, were the most common symptoms. A significantly higher proportion of oral manifestations was found in the 18-24 age range (χ²; p= 0.003). Among people who developed COVID-19 in a moderate to severe form, a greater number of oral symptom manifestations were observed (χ²; p= 0.044). Discussion: A high frequency of oral manifestations was identified in patients with moderate to severe cases of COVID-19, with taste disorders standing out as the most predominant. Younger individuals were the most affected.

A Comparative Study on the General and Otolaryngological Manifestations of COVID-19 in the Hospitalized Population of the Telangana Region During the First and Second Waves

Abstract Introduction Some common symptoms of Coronavirus disease 2019 (COVID-19) are fever, cough, and shortness of breath. But ear, nose, and throat (ENT) manifestations such as loss of smell and taste are also very common. Objectives To compare the general and otorhinolaryngological manifestations of COVID-19 and to compare the treatments given and mortality rate during its two waves. Methods This retrospective study was conducted on severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) cases in a tertiary care teaching hospital. Six hundred patients were included in the 1st wave sample and 516 were in the 2nd wave sample. The data collected included demographics, comorbidities, general, and ENT symptoms, need for ventilatory support, oxygen therapy, and mortality for both the waves. Results Fever, malaise, and myalgia were more frequently presented in the first wave than in the second, whereas shortness of breath was more common in the second wave. In the second wave, a significant increase in anosmia cases was reported, whereas sore throat, nasal obstruction, dysphagia, nasal discharge, and sneezing were significantly reduced compared with the first wave (p < 0.001). The case fatality rate increased from 11.33 to 21.55% (p < 0.001) from the 1st to the 2nd wave. The patients who died in the second wave were younger than those in the first wave. Two doses of vaccination showed protection from the death over those not vaccinated and those who only received one dose (p < 0.05). Conclusion Ear, nose, and throat (ENT) manifestations are very common along with the general symptoms. As anosmia and dysgeusia are early presenting symptoms in COVID-19 patients, all physicians should screen patients for ENT symptoms.

Oral manifestations and injuries related to covid- 19: an experience report on the role of hospital dentistry / Manifestações orais e lesões relacionadas à covid-19: um relatório de experiência sobre o papel da odontologia hospitalar / Manifestaciones orales y lesiones relacionadas con covid- 19: un informe de experiencia sobre el papel de la odontología hospitalaria

SARS-COV-2 is transmitted among human beings by saliva droplets that come in direct contact with the oral cavity, nose, and eyes. Since the mouth is one of the anatomical sites primarily contaminated, oral manifestations have also been reported beyond the serious consequences inherent to progressive respiratory failure. This study aimed to identify oral manifestations possibly related to the infection by COVID-19 in hospitalized patients. A prospective study was carried out with patients diagnosed with COVID-19 in the period between March and June 2021, admitted to the Moderate COVID-19 Care Unit of the Hans Dieter Schmidt Regional Hospital, by applying a form and performing a clinical exam of the oral cavity. Out of all patients (n=45), 33.3% reported both olfactory (anosmia) and taste dysfunction (dysgeusia), with an average duration of 5.9 ±3.0 days. Regarding other oral manifestations evaluated, two patients reported dry and burning mouth and one patient reported a change in taste associated with plaque-like changes in the tongue. No patients presented ulcers or other lesions in the oral cavity. Olfactory and taste dysfunction were symptoms recognized of the novel coronavirus disease (COVID-19). However, the association with other oral manifestations is still controversy. Unfortunately, dentistry professionals are still not part of most teams in the hospital environment, mostly because of the lack of prioritization of dental care. Working with a multidisciplinary team may avoid possible systemic complications due to poor dental care.

Sars-COV-2 é transmitida entre os seres humanos por gotículas de saliva que entram em contato direto com a cavidade oral, nariz e olhos. Uma vez que a boca é um dos sítios anatômicos principalmente contaminados, as manifestações orais também foram relatadas para além das graves consequências inerentes à insuficiência respiratória progressiva. Este estudo teve como objetivo identificar manifestações orais possivelmente relacionadas à infecção por Covid-19 em pacientes hospitalizados. Foi realizado um estudo prospetivo com pacientes diagnosticados com Covid-19 no período entre março e junho de 2021, internados na Unidade de Atendimento Moderado contra a Covid-19 do Hospital Regional Hans Dieter Schmidt, aplicando um formulário e realizando um exame clínico da cavidade oral. De todos os pacientes (n=45), 33,3% relataram disfunção olfativa (anosmia) e gustativa (disgeusia), com duração média de 5,9 ±3,0 dias. Em relação a outras manifestações orais avaliadas, dois pacientes relataram boca seca e ardente e um paciente relatou alteração no paladar associada a alterações semelhantes a placas na língua. Nenhum paciente apresentou úlceras ou outras lesões na cavidade oral. Disfunção olfativa e gustativa foram sintomas reconhecidos do novo coronavírus (Covid-19). No entanto, a associação com outras manifestações orais ainda é controversa. Infelizmente, os profissionais de odontologia ainda não fazem parte da maioria das equipes do ambiente hospitalar, principalmente por causa da falta de priorização dos cuidados odontológicos. Trabalhar com uma equipe multidisciplinar pode evitar possíveis complicações sistêmicas devido a cuidados odontológicos deficientes.

SARS-COV-2 se transmite entre los seres humanos por las gotitas de saliva que entran en contacto directo con la cavidad oral, la nariz y los ojos. Dado que la boca es uno de los sitios anatómicos principalmente contaminados, también se han informado manifestaciones orales más allá de las consecuencias graves inherentes a la insuficiencia respiratoria progresiva. El objetivo de este estudio fue identificar las manifestaciones bucales posiblemente relacionadas con la infección por COVID-19 en pacientes hospitalizados. Se realizó un estudio prospectivo con pacientes diagnosticados de COVID-19 en el periodo comprendido entre marzo y junio de 2021, ingresados en la Unidad de Cuidados Moderados de COVID-19 del Hospital Regional Hans Dieter Schmidt, mediante la aplicación de un formulario y la realización de un examen clínico de la cavidad oral. De todos los pacientes (n=45), el 33,3% notificó tanto disfunción olfativa (anosmia) como gustativa (disgeusia), con una duración media de 5,9 ±3,0 días. En cuanto a las demás manifestaciones orales evaluadas, dos pacientes notificaron sequedad y ardor de boca y un paciente notificó un cambio en el gusto asociado a cambios en la lengua en forma de placa. Ningún paciente presentó úlceras u otras lesiones en la cavidad oral. La disfunción olfativa y gustativa fueron síntomas reconocidos de la nueva enfermedad por coronavirus (COVID-19). Sin embargo, la asociación con otras manifestaciones orales es aún controvertida. Desafortunadamente, los profesionales de la odontología todavía no son parte de la mayoría de los equipos en el entorno hospitalario, principalmente debido a la falta de priorización de la atención odontológica. Trabajar con un equipo multidisciplinario puede evitar posibles complicaciones sistémicas debido a la mala atención dental.

Xerostomia and dysgeusia in the elderly: prevalence of and association with polypharmacy

Xerostomia is defined as the perception of dry mouth, and dysgeusia, as a change in taste. Both are common complaints in the elderly, especially among those making use of polypharmacy drug combinations. Aim: This study aimed to determine the prevalence of xerostomia and dysgeusia and to investigate their association with polypharmacy in the elderly. Methods: older people under follow-up at the Multidisciplinary Elderly Center of the University Hospital of Brasília were interviewed and asked about health problems, medications used, presence of xerostomia and dysgeusia. Descriptive statistics were used to determine the prevalence of the symptoms surveyed. The chi-square test was used to investigate the relationship between xerostomia and dysgeusia and polypharmacy. Secondary associations were performed using binomial logistic regression. Results: Ninety-six older people were evaluated and of these, 62.5% had xerostomia and 21.1%, had dysgeusia. The average number of medications used was 4±3 medications per individual. Polypharmacy was associated with xerostomia but not dysgeusia. It was possible to associate xerostomia with the use of antihypertensive drugs. Conclusion: Xerostomia was a frequent complaint among elderly people making use of polypharmacy, especially those using antihypertensives. Antihypertensives and antidepressants were used most drugs by the elderly and exhibited interactions with drugs most prescribed in Dentistry. Two contraindications were found between fluconazole and mirtazapine; and between erythromycin and simvastatin

Olfactory dysfunction in COVID-19: a marker of good prognosis? / Disfunção de olfato na Covid-19: marcador de bom prognóstico?

Abstract Introduction In May 2020, the World Health Organization recognized olfactory dysfunction as a COVID-19 symptom. The presence of hyposmia/anosmia may be a marker of good prognosis in COVID-19. Objective To associate the presence of olfaction disorder to the clinical condition severity in patients with COVID-19. Methods Individuals with the flu syndrome caused by SARS-CoV-2, diagnosed from March to June 2020, were recruited. They were divided into three groups: mild flu syndrome, severe flu syndrome (admitted to hospital wards) and critical illness (admitted to the ICU). Inpatients were interviewed by telephone contact after hospital discharge and their medical records were also evaluated regarding complementary test results. Outpatients answered an electronic questionnaire containing only clinical information. Results A total of 261 patients participated in the study: 23.75% with mild flu syndrome, 57.85% with severe flu syndrome and 18.40% with critical illness. A total of 66.28% patients with COVID-19 had olfaction disorders. In approximately 56.58% of the individuals the smell alterations lasted between 9 days and 2 months. There was a significantly higher proportion of individuals with olfactory dysfunction in the group with mild flu syndrome than in the severe flu syndrome group (mild × severe - p< 0.001; Odds Ratio = 4.63; 95% CI [1.87-10.86]). This relationship was also maintained between patients with mild flu syndrome and critically-ill patients (mild × critical - p< 0.001; Odds Ratio = 9.28; 95% CI [3.52-25.53]). Conclusion Olfaction dysfunction was significantly more prevalent in patients with mild flu syndrome in COVID-19. It may be a predictor of a good prognosis for this infection. New population-based studies must be carried out to corroborate these findings.

Resumo Introdução Em maio de 2020, a Organização Mundial da Saúde reconheceu a disfunção do olfato como um sintoma da C-19. A presença de hiposmia/anosmia pode ser um marcador de bom prognóstico na Covid-19. Objetivos Relacionar a presença do transtorno do olfato à gravidade do quadro clínico nos pacientes com Covid-19. Método Foram recrutados indivíduos com síndrome gripal causada pelo SARS-CoV-2, diagnosticados de março a junho de 2020. Eles foram divididos em três grupos: síndrome gripal leve; síndrome gripal grave (internados em enfermarias) e doença crítica (internados em UTI). Os doentes internados foram entrevistados por ligação telefônica após alta hospitalar e também tiveram seus prontuários avaliados para registro de exames complementares; os ambulatoriais responderam a um questionário eletrônico com somente informações clínicas. Resultados Participaram do estudo 261 pacientes: 23,75% com síndrome gripal leve, 57,85% com síndrome gripal grave e 18,40% com doença crítica. Ocorreu alteração do olfato em 66,28% doentes com Covid-19. Dos indivíduos, 56,58% apresentaram duração da alteração do olfato entre 9 dias e 2 meses. Houve significativamente maior proporção de indivíduos com disfunção olfatória no grupo com síndrome gripal leve do que nos graves (leves × graves - p < 0,001; odds ratio = 4,63; 95% IC [1,87-10,86]). Essa relação também se manteve entre os doentes leves e críticos (leves × críticos - p < 0,001; odds ratio = 9,28; 95% IC [3,52-25,53]). Conclusão A disfunção do olfato foi significantemente mais prevalente nos doentes com síndrome gripal leve na Covid-19. Pode ser um preditor de bom prognóstico dessa infecção. Novos estudos populacionais devem ser feitos para corroborar esses achados.

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.

Análise comparativa do tratamento do ardor bucal com terapia a laser de baixa intensidade e estimulação elétrica nervosa transcutânea: um ensaio clínico randomizado / Comparative analysis of the treatment of burning mouth with low-intensity laser therapy and transcutaneous electrical nerve stimulation: a randomized clinical trial

Introdução: O manejo de pacientes com ardor bucal é um desafio no cotidiano clínico da odontologia. Objetivo: Comparar o efeito da Terapia a Laser de Baixa Intensidade (LLLT) e da Estimulação Elétrica Nervosa Transcutânea (TENS) no tratamento do ardor bucal. Metodologia: Ensaio clínico randomizado constituído por 25 pacientes com ardor bucal que foram tratados por TENS (n=12) e por LLLT (n=13). Os protocolos de tratamento foram aplicados semanalmente por 8 semanas. O teste análise de variância (ANOVA) dois fatores foi usado para verificar se existia diferença significativa entre os tempos T0 (antes de iniciar o tratamento), T1 (após a 4ª sessão de tratamento), T2 (após a 8ª sessão de tratamento) e T3 (30 dias após o término do tratamento) em relação aos sintomas, analisados por meio da Escala Visual Analógica (EVA), fluxo salivar não estimulado, xerostomia e disgeusia com as intervenções de TENS e LLLT. Resultados: A maioria dos pacientes foi do sexo feminino no período pós-menopausa com média de idade no grupo TENS de 59,25 anos e no grupo LLLT de 62,08. Hipertensão e dislipidemia foram as alterações sistêmicas mais frequentes. Ansiedade e depressão foram os únicos transtornos psiquiátricos relados. A maioria dos pacientes fazia uso de medicamentos como anti-hipertensivos e antidepressivos. Não foram observadas variações expressivas no que se refere a xerostomia e a disgeusia nos dois grupos analisados. A TENS e a LLLT foram eficazes na redução dos sintomas relatados pelos pacientes (p˂0,001), entretanto, observou-se entre os tempos T2 e T3 que o grupo LLLT apresentou uma melhor resposta quando comparado ao TENS (p=0,003). Os pacientes do grupo TENS apresentaram aumento do fluxo salivar entre os tempos T1 e T2, enquanto o grupo LLLT apresentou uma diminuição (p=0,052). Conclusão: A TENS e a LLLT foram eficazes na redução dos sintomas do ardor bucal durante o tratamento e 30 dias após o término do tratamento, sendo que o grupo LLLT apresentou uma melhor resposta na sessão de acompanhamento pós-tratamento quando comparado ao grupo TENS (AU).

Introduction: The management of patients with burning mouth is a challenge in the clinical routine of dentistry. Objective: To compare the effect of Low Intensity Laser Therapy (LLLT) and Transcutaneous Electrical Nerve Stimulation (TENS) in the treatment of burning mouth. Methodology: Randomized clinical trial consisting of 25 patients with burning mouth who were treated with TENS (n=12) and LLLT (n=13). Treatment protocols were applied weekly for 8 weeks. The two-way analysis of variance (ANOVA) test was used to verify whether there was a significant difference between the times T0 (before starting treatment), T1 (after the 4th treatment session), T2 (after the 8th treatment session) and T3 (30 days after the end of treatment) in relation to symptoms, analyzed using the Visual Analogue Scale (VAS), unstimulated salivary flow, xerostomia and dysgeusia with TENS and LLLT interventions. Results: Most patients were female in the postmenopausal period, with a mean age of 59.25 years in the TENS group and 62.08 in the LLLT group. Hypertension and dyslipidemia were the most frequent systemic alterations. Anxiety and depression were the only psychiatric disorders reported. Most patients used drugs such as antihypertensives and antidepressants. Significant variations were not observed with regard to xerostomia and dysgeusia in the two groups analyzed. TENS and LLLT were effective in reducing the symptoms reported by patients (p˂0.001), however, it was observed between times T2 and T3 that the LLLT group showed a better response when compared to TENS (p=0.003). Patients in the TENS group showed an increase in salivary flow between times T1 and T2, while the LLLT group showed a decrease (p=0.052). Conclusion: TENS and LLLT were effective in reducing the symptoms of burning mouth during treatment and 30 days after the end of treatment, and the LLLT group showed a better response in the posttreatment follow-up session when compared to the TENS group (AU).

Parosmia and Dysgeusia after Intravenous Propofol?Based General Anesthesia: A Case Report

Various drugs, including anesthetic agents, can cause parosmia in the perioperative period. There are reported cases of patients with alterations of smell and taste due to local anesthetics, nerve damage, or as a side effect of general anesthesia. We present a case of a 58?year?old male who developed parosmia and dysgeusia in the postoperative period after radical nephrectomy and inferior vena cava thrombectomy. The anesthetics used were fentanyl and propofol for general anesthesia and ropivacaine for epidural analgesia. Clinical examination did not reveal any pathology

Coronavirus disease-19 vaccination and chemosensory dysfunction

Background: Chemosensory disturbances such as altered smell and taste sensations have a strong impact on health and quality of life. The lack of awareness of these chemosensory symptoms post-coronavirus disease (COVID)-19 vaccination has led to apprehension. When adequately addressed, it can encourage people to take vaccines which are a life-saving tool in this pandemic. Aims and Objectives: This study aims to assess the prevalence and duration of altered smell and taste post-COVID-19 vaccination. Materials and Methods: The survey was conducted during January–August 2021. The Institutional Ethical Committee clearance was obtained. Data was collected from 242 COVID-19 vaccine beneficiaries majority of them being health care workers by online and offline survey questionnaires. Descriptive analysis was done using SPSS 21. Results: Out of 250 respondents, 242 completed the study. About 95% of them received CoviShield, 3.8% Covaxin, and 1.3% Pfizer. Perception of altered smell (olfactory dysfunction), taste (gustatory dysfunction), and both smell and taste was reported by 5.8%, 8.27%, and 2.61% of study participants. The mean duration was 3.43 ± 2.03 and 4 ± 1.64 days for altered smell and taste, respectively, with complete recovery. Conclusion: Chemosensory disturbances were reported in a small percentage of vaccine beneficiaries and all of them recovered within a few days completely without any medications. Vaccines are a critical tool in the battle against COVID-19 and we should emphasize on its health and lifesaving benefits and reassure those chemosensory disturbances have complete recovery.

Clinical Signs and Symptoms Associated with COVID-19: A Cross Sectional Study / Signos y Síntomas Clínicos Asociados a COVID-19: Un Estudio Transversal

ABSTRACT: Covid-19 is a viral disease that has spread throughout the world, becoming a pandemic. Dysgeusia and anosmia are some of its most frequent symptoms. The aim of the study was to determine the frequent signs and symptoms associated with COVID-19 patients. A cross-secional study from 370 patients with acute respiratory illness admitted by emergenc y services of a hospital in Acapulco. An institutional survey was applied to all patients as a data collection instrument, and a SARS-CoV-2 test, by RT-PCR processed by a certified laboratory. Statistical analysis was performed using the STATA V13 program. The numerical variables without normality were reported in medians, 25th and 75th percentiles, and the Mann W ithney U test was performed for differences between groups. The categorical variables were presented in percentages and differences between groups with Chi-square test. A generalized linear models (GLM) analysis was carried out to determine the most frequent symptoms and signs associated with COVID-19. Clinical signs and symptoms associated to COVID-19 in the bivariate análysis were dysgeusia, odynophagia, anosmia, arthralgia, myalgia, conjunctivitis, and age older than 40 years. In the final multivariate model only age older than 40 years (OR) 2.2; CI 95 % 1.3,3.8) and dysgeusia (OR 2.1; CI95 % 1.2,3.6) kept significance. Dysgeusia, odynophagia, anosmia, arthralgia, myalgia and conjunctivitis are clinical signs and symptoms that can appear in the early stages of the disease, so they could be important for an early diagnosis.

RESUMEN: El Covid-19 es una enfermedad viral que se ha extendido por todo el mundo, convirtiéndose en una pandemia. La disgeusia y la anosmia son algunos de sus síntomas más frecuentes. El objetivo del estudio fue determinar los signos y síntomas frecuentes asociados con los pacientes con COVID-19. Estudio transversal de 370 pacientes con enfermedad respiratoria aguda ingresados por los servicios de emergencia de un hospital de Acapulco. A todos los pacientes se les aplicó una encuesta institucional como instrumento de recolección de datos, y una prueba de SARS-CoV-2, por RT-PCR procesada por un laboratorio certificado. El análisis estadístico se realizó utilizando el programa STATA V13. Las variables numéricas sin normalidad se reportaron en medianas, percentiles 25 y 75, y se realizó la prueba U de Mann Withney para diferencias entre grupos. Las variables categóricas se presentaron en porcentajes y diferencias entre grupos con la prueba de Chi-cuadrado. Se realizó un análisis de modelos lineales generalizados (GLM) para determinar los síntomas y signos más frecuentes asociados a la COVID-19. Los signos y síntomas clínicos asociados a COVID-19 en el análisis bivariado fueron disgeusia, odinofagia, anosmia, artralgia, mialgia, conjuntivitis y edad mayor de 40 años. En el modelo multivariado final solo la edad mayor de 40 años (OR) 2,2; IC 95 % 1,3,3,8) y la disgeusia (OR 2,1; IC95 % 1,2,3,6) mantuvieron significanca estadística. Disgeusia, odinofagia, anosmia, artralgias, mialgias y conjuntivitis son signos y síntomas clínicos que pueden aparecer en etapas tempranas de la enfermedad, por lo que podrían ser importantes para un diagnóstico precoz.

Disgeusia como principal manifestación oral en pacientes con COVID-19 leve en el Instituto Nacional de Enfermedades Respiratorias / Dysgeusia as the main oral manifestation in patients with mild COVID-19 at the National Institute of Respiratory Diseases

Objetivo. Reportar las manifestaciones orales más comunes asociadas a COVID-19 así como si estas persisten en un período de 3 meses. Métodos. Se realizó un estudio longitudinal, descriptivo, evaluando a 149 individuos positivos por reacción en cadena de la polimerasa (PCR) para SARS-CoV-2 a los cuales se les realizó un estudio inicial y un control 3 meses después. Resultados. El 65% de los participantes reportó alguna manifestación en cavidad bucal y el 24% alguna secuela. Dentro de estos síntomas y secuelas bucales observados, la de mayor frecuencia fue la disgeusia la cual se encontró en 51% de los pacientes seguida por xerostomía 27%, ganglios o glándulas inflamadas (17%). Dichas manifestaciones disminuyeron de forma importante en el seguimiento, sin embargo, prevalecieron en algunos pacientes. Conclusiones. La disgeusia es la manifestación oral de mayor frecuencia en este estudio y se presentó entre las cinco manifestaciones generales más comunes.

Objective. To report the oral manifestations associated with COVID-19 as well as whether these persist over a period of 3 months. Methods. A longitudinal, descriptive study was carried out evaluating 149 individuals positive for SARS-CoV-2 by polymerase chain reaction (PCR), who underwent an initial examination and a control 3 months later. Results. A total of 65% of the participants reported some manifestation in the oral cavity and 24% some sequelae. Within these observed symptoms and oral sequelae, the one with the highest incidence was dysgeusia, which was found in 51% of patients followed by xerostomia (27%), lymph nodes or swollen glands (17%). These manifestations decreased significantly during the follow-up, however they prevailed in some patients. Conclusions. Dysgeusia is the oral manifestation with the highest incidence in this study and was among the 5 most common general manifestations.

Características y prevalencia de las alteraciones del olfato y el gusto en pacientes con infección por COVID-19 / Characteristics of smell and taste alteration in patients with COVID-19

Introducción: La identificación de los síntomas o sus combinaciones con un alto valor predictivo para la enfermedad, es una estrategia crucial para el control de las enfermedades transmisibles. Las alteraciones en el olfato y el gusto han surgido como síntomas de alta prevalencia y un confiable predictor temprano de la enfermedad. El objetivo de este estudio fue caracterizar la prevalencia de las alteraciones del gusto y del olfato en pacientes con antecedente de infección por SARS-CoV-2 en la población colombiana. Materiales y métodos: estudio descriptivo de corte transversal. Se realizó una encuesta telefónica y electrónica a pacientes adultos con antecedente de infección por SARS-CoV-2 confirmado por PCR. Resultados: se incluyeron 182 pacientes en el estudio. El 59% manifestó alteraciones del olfato y 54% alteraciones del gusto. De estos, el 77% y 82%, respectivamente, presentaron mejoría de sus síntomas. El 14% de los participantes percibió las alteraciones del olfato antes del inicio de otros síntomas de COVID-19. El 9% reportó que la alteración del olfato fue el único síntoma de la infección. Para el gusto, 8% informó que fue el primer síntoma de COVID-19, mientras que el 6% reportó que fue el único síntoma. Conclusiones: las alteraciones del gusto y del olfato son síntomas de alta prevalencia en pacientes con infección por COVID-19 y en algunos casos pueden ser el síntoma de presentación de la infección o el único síntoma de la infección

Introduction: Identifying symptoms or symptom combinations with a high predictive value for diagnosing a disease is a crucial strategy for controlling transmissible diseases. Smell and taste alterations have been identified as highly prevalent symptoms of COVID-19 and have been used as a reliable early predictor of the disease. The objective in this study was characterizing the prevalence of smell and taste alterations in patients with COVID-19 in the Colombian population. Materials and methods: Cross-sectional, descriptive study. A telephonic and electronic survey was applied to adult patients with SARS-CoV-2 infection confirmed by PCR. Results: 182 patients were included. 59% presented with smell alterations and 54% with taste symptoms. Among these patients, 77% and 82% respectively perceived symptomatic improvement. 14% of patients presented smell alterations before the onset of other COVID-19 symptoms. 9% reported smell alterations to be the only symptom of the disease. 8% of patients perceived taste alterations as a first symptom and 6% reported it to be the only symptom of the disease. Conclusion: Taste and smell alterations are highly prevalent symptoms in Colombian patients with Covid-19 and in some cases they can be the either the first or the only perceived symptoms of the disease.

Síntomas otorrinolaringológicos asociados con infección positiva de SARS-CoV-2 confirmada con RT-PCR: un estudio de casos y controles en Colombia / Otolaryngological symptoms associated with positive RT-PCR SARS-CoV-2 infection: a case-control study in Colombia

Introducción: las alteraciones otorrinolaringológicas en pacientes con COVID-19 tienen particular importancia a nivel mundial. Sin embargo, todavía no hay consenso en la literatura acerca de la epidemiología, la gravedad y el tiempo de recuperación de estos trastornos. Objetivo: este estudio tiene como objetivo evaluar la asociación entre los síntomas otorrinolaringológicos y la positividad del SARS-CoV-2 confirmada mediante la reacción en cadena de la polimerasa de transcripción inversa (RT-PCR), así como la gravedad, duración y recuperación de estos síntomas en pacientes de la Fundación Santa Fe de Bogotá, un hospital de referencia de COVID-19 en Bogotá, Colombia. Métodos: estudio observacional, prospectivo, tipo casos y controles, realizado entre el 9 de octubre de 2020 y el 14 de enero de 2021. Los casos incluyeron adultos que obtuvieron una prueba positiva para el SARS-CoV-2 mediante RT-PCR. Los casos se emparejaron en una proporción de 2:1 con adultos sintomáticos seleccionados al azar con una prueba negativa, o con pacientes prequirúrgicos. Resultados: se incluyeron 130 casos y 253 controles entre los 10.004 pacientes sometidos a la prueba del SARS-CoV-2. La edad media era de 41,8 años (desviación estándar [DE]: 16,3). Los síntomas otorrinolaringológicos asociados a la positividad al SARS-CoV-2 fueron anosmia/hiposmia (adjusted odds ratio [aOR]: 5,82; intervalo de confianza [IC] del 95 %: 1,92-17,68), disgeusia/hipogeusia (aOR: 9,09; IC del 95 %: 2,86-28,92) y tos seca (aOR: 3,18; IC del 95 %: 1,56-6,48). La duración media de la anosmia/hiposmia y de la disgeusia/hipogeusia en los pacientes con SARS-CoV-2 positivos fue de 14,5 días y 15 días (rango intercuartílico [IQR]: 8-27), respectivamente. Hasta el 70,3 % y el 67,5 % de la población informó de una recuperación completa de la anosmia/hiposmia y la disgeusia/hipogeusia. En cuanto a la gravedad de los síntomas de anosmia/hiposmia y disgeusia/hipogeusia, el 62,1 % y el 65,4 % de la población positiva para SARS-CoV-2 los clasificó como graves. Sin embargo, solo el 6,1 % de ellos recibió tratamiento para estos síntomas. Conclusiones: los síntomas otorrinolaringológicos asociados con la positividad para SARS-CoV-2 son útiles para orientar el diagnóstico, pero establecer sus características clínicas también es esencial para un tratamiento adecuado.

Introduction: Otolaryngological disorders in COVID-19 patients have drawn attention worldwide. However, there is still no consensus regarding the prevalence, severity or recovery of these disorders. This study aimed to assess the association between otolaryngological symptoms and SARS-CoV-2 positivity confirmed by RT-PCR, as well as the severity, duration, and recovery of these symptoms in patients receiving care at Fundación Santa Fe de Bogotá, a COVID-19 referral hospital in Bogotá, Colombia. Methods: Observational, analytic, prospective, case-control study conducted between October 9, 2020, and January 14, 2021. Cases included adults who tested positive for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR). Cases were matched in a 2:1 ratio with randomly selected symptomatic adults with a negative test, or patients awaiting surgery. Results: Of 10004 patients tested for SARS-CoV-2, 130 cases and 253 controls were included. The mean age was 41.8 years (standard deviation [SD]: 16.3). The otolaryngological symptoms associated with SARS-CoV-2 positivity were anosmia/hyposmia (adjusted odds ratio [aOR]: 5.82; 95% confidence interval [CI]: 1.92-17.68), dysgeusia/ hypogeusia (aOR: 9.09; 95% CI: 2.86-28.92), and dry cough (aOR: 3.18; 95% CI: 1.56-6.48). The median duration of anosmia/hyposmia and dysgeusia/hypogeusia in SARS-CoV-2 positive patients was 14.5 days and 15 days (interquartile range [IQR]: 8-27), respectively. Up to 70.3% and 67.5% of the population reported a complete recovery of anosmia/hyposmia and dysgeusia/hypogeusia. Regarding the severity of anosmia/hyposmia and dysgeusia/hypogeusia symptoms, 62.1% and 65.4% of the SARS-CoV-2 positive population classified them as severe. However, only 6.1% of them received treatment for these symptoms. Conclusions: Otolaryngological symptoms associated with SARS-CoV-2 positivity are a useful guide to diagnosis, although adequate treatment also requires determination of their clinical characteristics.

Transtornos del olfato y el gusto, de las bases a la práctica clínica / Smell and Taste Disorders. From the Basics to the Clinical Practice

Resumen Alrededor de una cuarta parte de la población de adultos de más de 40 años presenta algún trastorno del olfato. Las alteraciones primarias del gusto son menos frecuentes y suelen atribuirse a un problema del olfato concomitante. Ambos tienen un fuerte impacto en la calidad de vida de las personas que lo padecen, generando depresión, aislamiento y sensación de vulnerabilidad. El grado de disfunción del olfato y el gusto han sido utilizados como predictor de mortalidad y pronóstico en ciertas enfermedades. Las etiologías son diversas e incluyen desde problemas nasosinusales hasta enfermedades neurodegenerativas. Existen diversas pruebas, fáciles de aplicar y almacenar, que permiten al clínico medir de manera objetiva el grado de disfunción de estos sistemas. El propósito de este artículo de revisión es mostrar al médico de cualquier área, la importancia de explorar estos sistemas y cómo realizarlo. También se discuten las distintas opciones de tratamiento y rehabilitación.

Abstract It is estimated that around 25% of adults over 40 years have some form of smell disorder. The primary taste disfunctions are less frequent and they are usually caused by some olfactory alteration. They both have an important impact on the quality of life of people who suffer from them, predisposing to depression, isolation and vulnerability. The degree of smell and taste dysfunction have been used as mortality predictor and prognosis in certain diseases. The etiologies go from sinonasal causes to neurodegenerative diseases. There are multiple identification tests that let us objectively know the magnitude of these disorders. The objective of these article is to show the healthcare personnel the importance of these senses, how to explore their alterations, how to approach them and their possible management and rehabilitation.

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.

Dysgeusia and COVID-19: the Importance of the Dentist in the Diagnostic / Disgeusia y COVID-19: la Importancia del Dentista en el Diagnóstico

Dysgeusia is understood as changes in the perception of taste in patients infected with COVID-19 and has been frequently observed in the early stages of the disease. Along with the causes of dysgeusia, we can mention the correlation with infectious conditions, being of importance for the differential diagnosis. Dysgeusia can be considered one of the first manifestations of COVID-19, being an important contribution in the search for solutions regarding early diagnosis and treatment, in addition to its hospital and laboratory application.

La disgeusia se entiende como cambios en la percepción del gusto en pacientes infectados por COVID-19 y se ha observado con frecuencia en las primeras etapas de la enfermedad. Junto a las causas de la disgeusia, podemos mencionar la correlación con patologías infecciosas, siendo de importancia para el diagnóstico diferencial. La disgeusia se puede considerar como una de las primeras manifestaciones del COVID-19, siendo un aporte importante en la búsqueda de soluciones en cuanto al diagnóstico y tratamiento precoces, además de su aplicación hospitalaria y de laboratorio.

Avaliação da Percepção do Paladar de Pacientes Oncológicos: Relação com Variáveis Pessoais e Clínicas e Comparação com um Grupo Controle / Evaluation of Taste Perception of Oncological Patients: Relationship with Personal and Clinical Variables and Comparison with a Control Group / Evaluación de la Percepción del Sabor de Pacientes Oncológicos: Relación con Variables Personales y Clínicas y Comparación con un Grupo de Control

Introdução: O tratamento antineoplásico pode causar efeitos colaterais que prejudicam a ingestão alimentar e o estado nutricional dos pacientes. Objetivo: Avaliar a percepção do paladar de pacientes em tratamento oncológico, relacioná-la com as variáveis pessoais e clínicas e compará-la com a percepção do paladar de indivíduos sadios. Método: Trata-se de um estudo transversal com 50 indivíduos em tratamento oncológico e outros 50 indivíduos do grupo controle. Para avaliar a percepção do paladar, os participantes receberam amostras de alimentos e foram questionados quanto aos sabores doce, amargo, salgado e azedo. A intensidade do sabor foi avaliada por meio de uma escala de 1 a 5. Resultados: Os pacientes em tratamento oncológico perceberam os sabores dos seguintes alimentos de maneira mais acentuada: doce de leite (4,48±1,0 vs. 3,78±0,9; p<0,05), goiabada (4,10±1,0 vs. 3,52±0,9; p<0,05), suco de limão (4,42±0,9 vs. 2,86±1,0; p<0,05), suco de maracujá (3,76±1,2 vs. 2,56±1,0; p<0,05) e café (4,42±0,8 vs. 3,14±0,9; p<0,05). Já os alimentos: biscoito de polvilho, iogurte natural, rúcula e chicória foram percebidos com menor intensidade quando comparados ao grupo controle. Entre as quatro categorias de sabor avaliadas, os alimentos do grupo salgado foram os que menos se diferenciaram quanto à percepção do paladar e os alimentos azedos e amargos foram percebidos de forma mais distinta entre os grupos. Conclusão: O presente estudo é pioneiro em avaliar a percepção do paladar utilizando alimentos, ao invés de soluções padronizadas; e, por meio dessa técnica, identificaram-se diferenças significativas na intensidade da percepção do paladar dos indivíduos em tratamento oncológico.

Introduction: Antineoplastic treatment can cause side effects that impair the patients' food intake and nutritional status. Objective: To evaluate the taste perception in patients undergoing cancer treatment, to relate it to personal and clinical variables and to compare with taste perception in healthy individuals. Method: Cross-sectional study with 50 individuals undergoing cancer treatment and another 50 individuals in the control group. To assess taste perception, participants received food samples and were asked about sweet, bitter, salty and sour flavors. The intensity of the flavor was assessed using a scale from 1 to 5. Results: Patients undergoing cancer treatment perceived the flavors of the following foods more strongly: dulce de leche (4.48±1.0 vs. 3.78±0.9; p<0.05), guava (4.10±1.0 vs. 3.52±0.9; p<0.05), lemon juice (4.42±0.9 vs. 2.86±1.0; p<0.05), passion fruit juice (3.76±1.2 vs. 2.56±1.0; p<0.05) and coffee (4.42±0.8 vs. 3.14±0.9; p<0.05). The foods: cassava starch, natural yogurt, arugula and chicory were perceived with less intensity when compared to the control group. Among the four flavor categories evaluated, the foods in the salty group were the ones that least differed in terms of the taste perception and sour and bitter foods were perceived more distinctly between the groups. Conclusion: The present study is pioneer in evaluating the taste perception using food, instead of standardized solutions, and through this technique, significant differences were identified in the intensity of taste perception of individuals undergoing cancer treatment.

Introducción: El tratamiento antineoplásico puede causar efectos secundarios que perjudican la ingesta de alimentos y el estado nutricional de los pacientes. Objetivo: Evaluar la percepción del gusto en pacientes sometidos a tratamiento contra el cáncer, relacionarlo con variables personales y clínicas y compararlo con la percepción del gusto en individuos sanos. Método: Este es un estudio transversal con 50 individuos en tratamiento contra el cáncer y otros 50 individuos en el grupo de control. Para evaluar la percepción del sabor, los participantes recibieron las muestras de alimentos y se les preguntó sobre los sabores dulces, amargos, salados y agrios. La intensidad del sabor se evaluó usando una escala del 1 al 5. Resultados: Los pacientes en tratamiento contra el cáncer percibieron los sabores de los siguientes alimentos con más fuerza: dulce de leche (4,48±1,0 vs. 3,78±0,9; p<0,05), guayaba (4,10±1,0 vs. 3,52±0,9; p<0,05), jugo de limón (4,42±0,9 vs. 2,86±1,0; p<0,05), jugo de maracuyá (3,76±1,2 vs. 2,56±1,0; p<0,05) y café (4,42±0,8 vs. 3,14±0,9; p<0,05). Los alimentos: galletas de almidón, yogur, rúcula y achicoria se percibieron con menos intensidad en comparación con el grupo de control. Entre los sabores, los alimentos salados fueron los que menos diferían y los alimentos amargos y amargos se percibieron más claramente entre los grupos. Conclusión: El presente estudio es pionero en evaluar la percepción del gusto utilizando alimentos, en lugar de soluciones estandarizadas, y identificó diferencias significativas en la intensidad de la percepción del gusto en individuos en tratamiento contra el cáncer.

Longitudinal study on the correlation between taste alteration and quality of life among nasopharyngeal carcinoma patients undergoing radiotherapy / 中国实用护理杂志

Objective@#To study the prevalence of taste alteration and the changes of life quality with nasopharyngeal carcinoma patients during radiotherapy period, then analyze the correlation between them.@*Methods@#Sixty patients with nasopharyngeal carcinoma in Zhejiang Cancer Hospital from October 2018 to February 2019 were interviewed during radiotherapy period, Chemotherapy-induced Taste Alteration Scale and European Organization for Research and Treatment of Cancer-quality of life head and neck module were used at four times points, which were the beginning of radiotherapy,10 F and 20 F after radiotherapy, and the end of radiotherapy.@*Results@#The score of taste alteration at the beginning of radiotherapy,10 F and 20 F after radiotherapy, and the end of radiotherapy were 22.02 ± 0.60, 45.85 ± 2.27, 55.75 ± 2.21, 63.7 ± 2.13, the life quality score at the beginning of radiotherapy,10 F and 20 F after radiotherapy, and the end of radiotherapy were 7.59 ± 0.84, 25.68 ± 2.00, 35.86 ± 2.43, 44.84 ± 2.73, both were significantly different(F=131.43, 116.85, all P<0.01). Spearman correlation analysis showed that there were positive correlation between taste alteration and quality of life(r=0.244-0.674, all P<0.05 or 0.01).@*Conclusions@#The main finding of this study is that taste impairment in nasopharyngeal carcinoma patient was increased as the radiotherapy continues, and the correlation between quality life and taste alteration was significantly enhanced, which should be afforded greater attention from medical staff.

Alteraciones en la cavidad bucal en pacientes tratados con radioterapia de cabeza y cuello. Medellín, Colombia / Alterations found in the mouth of patients treated with head and neck radiotherapy. Medellin, Colombia

El objetivo del estudio fue determinar las alteraciones bucales en pacientes con cáncer de cabeza y cuello tratados con radioterapia y explorar la participación del Odontólogo en la atención de estos pacientes. Se realizó un estudio exploratorio en 52 pacientes que habían recibido más de 1,000 cGy de radiación. Se encuestó y realizó examen bucal a cada participante, tasa de flujo salivar estimulado y prueba de sabores. Los resultados muestran alta prevalencia de alteraciones bucales en pacientes con radiación acumulada entre 3,001 y 5,000 cGy. La boca seca (xerostomía) fue la alteración más sentida (78.8%). La tasa de secreción salivar total estimulada confirmó hiposalivación en el 82.7% de los pacientes. Se encontró una asociación estadísticamente significativa entre el lugar del cáncer (p < 0.01) y el tipo de tumor con la presencia de trismus (p < 0.05). La hiposialia se presentó más en los pacientes con tumores en estadio IV (50%) y en aquellos sometidos a tratamientos combinados (p < 0.05). Fue posible realizar la valoración periodontal al 50% de los pacientes, el 92% de ellos presentó periodontitis con pérdida de inserción principalmente severa y moderada. El 84.6% de los participantes manifestaron no haber sido remitidos a odontólogo antes o durante el tratamiento. Los hallazgos ratifican una alta frecuencia de alteraciones bucales en pacientes sometidos a tratamiento de radioterapia e inoportunidad de atención odontológica para prevenir o tratar estos efectos. Se alerta sobre la obligatoriedad de seguir protocolos de manejo del paciente oncológico, incluyendo valoración odontológica antes, durante y después del tratamiento respectivo.

The aim of the present study was to determine which oral alterations can be found in patients with head and neck cancer treated with radiotherapy as well as to explore dentist's involvement in treatment of these patients. An exploratory study was conducted in 52 patients who had previously received over 1,000 cGy radiation. A survey was undertaken as well as oral examination of each participant, in order to assess stimulated salivary flow and flavor tests. Results revealed high prevalence of oral alterations in patients with accumulated radiation of 3,001-5,000 cGy. Dry mouth (xerostomia) was the most frequently reported alteration (78.8%). Estimated total salivary secretion rate confirmed a state of hyposalivation in 82.7% of all patients. A statistically significant association was found between cancer location (p < 0.01) and type of tumor with presence of trismus (p < 0.05). Hyposialia was more frequently present in patients with stage IV tumors (50%) in those subjected to combined treatments (p < 0.05). Periodontal assessment was possible in 50% of all patients, Of this proportion, 92% exhibited periodontitis with mainly moderate to severe insertion loss; 84.6% of all participants reported not to have been remitted to dentists either before or after treatment. Findings support high frequency of oral alterations in patients subjected to radiotherapy treatment and dental care inappropriateness to prevent or treat these effects. An alert is raised with respect to the compulsiveness to follow treatment protocols for cancer patients, which should include dental evaluation before, during and after respective treatment.