ABSTRACT
BACKGROUND: Sudden smell loss is a specific early symptom of COVID-19, which, prior to the emergence of Omicron, had estimated prevalence of ~40% to 75%. Chemosensory impairments affect physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. The aim of this cohort study was to characterize smell function and recovery up to 11 months post COVID-19 infection. METHODS: This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial survey (S1) about respiratory symptoms, chemosensory function and COVID-19 diagnosis between April and September 2020, were invited to complete a follow-up survey (S2). Between September 2020 and February 2021, 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness. RESULTS: At follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID illness. The ability to smell during COVID-19 was rated slightly lower by those who did not eventually recover their pre-illness ability to smell at S2. CONCLUSIONS: While smell ability improves for many individuals who lost it during acute COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is associated with broader persistent symptoms of COVID-19, and may last for many months following acute COVID-19. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that even conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.
ABSTRACT
Background: Rectal cancer treatment has evolved during the past 40 years thanks to the advancements in imaging, pathology, surgical treatments, radiotherapy, and chemotherapy, within a multidisciplinary team approach providing an optimum health care. Many studies have demonstrated how the social environment can affect the treatment and outcome in neoplastic patients. The primary endpoint of this study was to compare the Health Equity Audit (HEA) before and after the establishment of a structured pathway for the management of neoplasms of the rectum. Methods: This was a retrospective study carried out at the University Hospital of Ferrara, Italy, on selected patients with rectal cancer stage < IIIb, who were diagnosed and treated in the year 2012 (Group 1:35 patients), before the start of the rectal cancer multidisciplinary team, and in the year 2020 (Group 2: 35 patients), after the setting up of the rectal cancer multidisciplinary team. For each patient we considered different social variables: age at time of diagnosis, gender, distance in km from the centre of treatment, level of education. We analysed the following indicators: Indicator 1: time between the first symptoms and diagnosis;Indicator 1b: % of patients coming from screening programs;Indicator 2: time between the communication of diagnosis and the beginning of the treatment;Indicator 3: adherence to treatment;Indicator 4: time between the end of neoadjuvant treatment and surgery. Results: The characteristics of the patients at baseline were well balanced between the two groups. Indicator 1 goal was achieved in 64% of the patients in group 1 and in 73,9% of the patients in group 2. Indicator 2 goal was achieved in 35,3% of group 1 and 55,6 % of group 2. In group 1, 71% of patients who lived less than 30 km away from our center met the indicator 2 criteria while only 33% of patients who lived more than 30 kms away had the same result. In group 2, 53% of patients who lived less than 30 km away from our center met the indicator 2 criteria while none of the patients who lived more than 30 kms away did. In addition, we found out that in group 1 the rate of patients who met indicator 2 goal increased with level of education. These preliminary results demonstrated that equality seems to have improved after 8 years despite the Covid pandemic in 2020. Conclusions: The introduction of a dedicated treatment pathway appears to have improved Health Equity for patients with rectal cancer.