Effects of Multidisciplinary Rehabilitation Enhanced with Neuropsychological Treatment on Post-Acute SARS-CoV-2 Cognitive Impairment (Brain Fog): An Observational Study.

Concentration and memory impairment (named "brain fog") represents a frequent and disabling neuropsychological sequela in post-acute COVID-19 syndrome (PACS) patients. The aim of this study was to assess whether neurocognitive function could improve after a multidisciplinary rehabilitation program enhanced with individualized neuropsychological treatment. A prospective monocentric registry of PACS patients consecutively admitted to our Rehabilitation Unit was created. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive impairment at admission and discharge. A total of sixty-four (64) PACS patients, fifty-six (56) of them with brain fog, were treated with a day-by-day individualized psychological intervention of cognitive stimulation (45 min) on top of a standard in-hospital rehabilitation program. The mean duration of the acute-phase hospitalization was 55.8 ± 25.8 days and the mean in-hospital rehabilitation duration was 30 ± 10 days. The mean age of the patients was 67.3 ± 10.4 years, 66% of them were male, none had a previous diagnosis of dementia, and 66% of the entire sample had experienced severe COVID-19. At admission, only 12% of the patients had normal cognitive function, while 57% showed mild, 28% moderate, and 3% severe cognitive impairment. After psychological treatment, a significant improvement in the MoCA score was found (20.4 ± 5 vs. 24.7 ± 3.7; p < 0.0001) as a result of significant amelioration in the following domains: attention task (p = 0.014), abstract reasoning (p = 0.003), language repetition (p = 0.002), memory recall (p < 0.0001), orientation (p < 0.0001), and visuospatial abilities (p < 0.0001). Moreover, the improvement remained significant after multivariate analysis adjusted for several confounding factors. Finally, at discharge, 43% of the patients with cognitive impairment normalized their cognitive function, while 4.7% were discharged with residual moderate cognitive impairment. In conclusion, our study provides evidence of the effects of multidisciplinary rehabilitation enhanced with neuropsychological treatment on improvement in the cognitive function of post-acute COVID-19 patients.

Olfactory training with essential oils for patients with post-COVID19 smell dysfunction: a case series

Introduction It is estimated that up to one third of COVID-19 patients can develop long-lasting smell dysfunction. Viral infections, especially COVID-19, can cause anosmia through different pathomechanisms and different strategies have been proposed for effectively managing post-COVID-19 olfactory dysfunction in clinical practice, with olfactory training being recommended as a first-line treatment option. Methods This report describes a non-consecutive series of clinical cases. After COVID-19, eight cases (5 females, 3 males) of adult patients with long-lasting (3+ months) postviral smell dysfunction followed a 30-day olfactory training protocol with a set of plant-derived essential oils. At baseline and at the end of the treatment, the patients were administered the Assessment of Self-reported Olfactory Functioning (ASOF) questionnaire, an inventory used to measure olfactory dysfunction and health-related quality of life. Results For any of the outcomes assessed with the ASOF scale, a significant change-from-baseline improvement was reported, even though mean value ameliorations were more pronounced for olfactory function per se (Subjective Olfactory Capability: from 3.6 to 5.6 out of 10;Self-Reported capability of Perceiving specific odors: from 1.8 to 3.0 out of 5), rather than for health-related quality of life (Olfactory-Related Quality of life: from 2.9 to 3.9 out of 6). Conclusions It was observed that patients with long-lasting COVID-19-related smell dysfunction improved after a 30-day olfactory training protocol. Further controlled clinical studies would be useful to better investigate the role of olfactory training in patients with post-infective smell dysfunction.

Antigen Detection Tests for SARS-CoV-2: a systematic review and meta-analysis on real world data.

Background and aim Rapid antigen detection (RAD) tests on nasopharyngeal specimens have been recently made available for SARS-CoV-2 infections, and early studies suggested their potential utilization as rapid screening and diagnostic testing. The present systematic review and meta-analysis was aimed to assess available evidence and to explore the reliability of antigenic tests in the management of the SARS-CoV-2 pandemic. MATERIALS AND METHODS: We reported our meta-analysis according to the PRISMA statement. We searched Pubmed, Embase, and pre-print archive medRxiv.og for eligible studies published up to November 5th, 2020. Raw data included true/false positive and negative tests, and the total number of tests. Sensitivity and specificity data were calculated for every study, and then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure. Reporting bias was assessed by means of funnel plots and regression analysis. RESULTS: Based on 25 studies, we computed a pooled sensitivity of 72.8% (95%CI 62.4-81.3), a specificity of 99.4% (95%CI 99.0-99.7), with high heterogeneity and risk of reporting bias. More precisely, RAD tests exhibited higher sensitivity on samples with high viral load (i.e. <25 Cycle Threshold; 97.6%; 95%CI 94.1-99.0), compared to those with low viral load (≥25 Cycle Threshold; 43.6%; 95% 27.6-61.1). DISCUSSION: As the majority of collected reports were either cohort or case-control studies, deprived of preventive power analysis and often oversampling positive tests, overall performances may have been overestimated. Therefore, the massive referral to antigenic tests in place of RT-qPCR is currently questionable, and also their deployment as mass screening test may lead to intolerable share of missing diagnoses. On the other hand, RAD tests may find a significant role in primary care and in front-line settings (e.g. Emergency Departments). (www.actabiomedica.it).

Appropriate use of essential oils and their components in the management of upper respiratory tract symptoms in patients with COVID-19.

INTRODUCTION: The involvement of the upper respiratory tract is common in COVID-19, and the majority of patients are treated at home with a mild-to-moderate form of the disease. Many approaches based on essential oils have been proposed for the symptomatic treatment of COVID-19. This work aims to outline the potential and safe evidence-based uses of essential oils and their major components for the clinical management of mild respiratory symptoms caused by uncomplicated coronavirus infections, including SARS-CoV-2. Due to their wide use, a focus on the constituents eucalyptol and menthol has been provided. METHODS: An overview of the scientific literature with a critical discussion of retrieved evidence and clinical recommendations. RESULTS: In general, eucalyptol and essential oils or blends whose content is rich in it, may be used as an integrative remedy for the symptomatic improvement of patients with mild and uncomplicated infections caused by coronaviruses. Menthol is not recommended in patients with COVID-19, due to a potential reduction of the self-perception of dyspnea, which can lead infected patients to underestimate the actual disease severity and to delay medical attention. DISCUSSION: Based on available evidence, symptomatic remedies for COVID-19, such as essential oils and their isolated compounds, can be useful, but are not an alternative to standard medical therapy and do not exempt patients from following precautionary measures issued by health authorities. Clinical recommendations on the appropriate use of essential oils for the management of upper airway symptoms of COVID-19 are provided. Further studies on the topic are advised.

Respiratory rehabilitation for post-COVID19 patients in spa centers: first steps from theory to practice.

With this correspondence, we would like to briefly outline a practical perspective about a possible integrative and effective management in spa settings of COVID-19 long-term sequelae, with a keen focus on post-infective lung damage and fibrosis, which is expected to become epidemiologically relevant in the general population. In order to outline a standard/baseline model of care, we think that it can be useful to refer to already existing rehabilitative plans with a long-standing tradition in Italy, such as those ones prescribed for work-related respiratory diseases like pneumoconiosis, in which long-term outcomes share some clinical characteristics with post-infective lung fibrosis. Such programs include diagnostic procedures (spirometry, ECG, blood tests) and treatments like respiratory physio-kinesiotherapy and postural drainage of the lungs; mechanical pulmonary ventilation for rehabilitative purposes, with or without drugs, along with standard medical and, when required, oxygen therapy; inhalation therapies with mineral waters; physical activity and psychological support. In conclusion, we believe that spa facilities can be a proper setting for respiratory rehabilitation and that already existing programs employed in occupational medicine can be a good starting point to plan rehabilitative strategies for post-COVID-19 patients. In particular, health spa centers can be useful not only to offer tailored programs of physical rehabilitation but also to provide patients with a psychologically supportive and health-promoting environment. Further studies on the topic are advised to properly assess and quantify with adequate outcome measurements the beneficial effect of a spa-based rehabilitative program in post-COVID-19 patients.