The 8-Odorant Barcelona Olfactory Test (BOT-8): Validation of a New Test in the Spanish Population During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVE: Most smell tests are difficult to implement in daily clinical practice owing to their long duration. The aim of the present study was to develop and validate a short, easy-to-perform, and reusable smell test to be implemented during the COVID-19 pandemic. METHODS: The study population comprised 120 healthy adults and 195 patients with self-reported olfactory dysfunction (OD). The 8-Odorant Barcelona Olfactory Test (BOT-8) was used for detection, memory/recognition, and forced-choice identification. In addition, a rose threshold test was performed, and a visual analog scale was applied. The Smell Diskettes Olfaction Test (SDOT) was used for correlation in healthy volunteers, and the University of Pennsylvania Smell Identification Test (UPSIT) was used for patients with OD to establish cut-offs for anosmia and hyposmia. In order to take account of the COVID-19 pandemic, disposable cotton swabs with odorants were compared with the original test. RESULTS: In healthy persons, the mean (SD) BOT-8 score was 100% for detection, 94.5% (1.07) for memory/recognition, and 89.6% (0.86) for identification. In patients with OD, the equivalent values were 86% (32.8), 73.2% (37.9), and 77.1% (34.2), respectively. BOT-8 demonstrated good test-retest reliability, with agreement of 96.7% and a quadratic k of 0.84 (P<.001). A strong correlation was observed between BOT-8 and SDOT (r=0.67, P<.001) and UPSIT (r=0.86, P<.001). Agreement was excellent for disposable cotton swabs, with a k of 0.79 compared with the original test. The cut-off point for anosmia was ≤3 (area under the curve, 0.83; sensitivity, 0.673; specificity, 0.993). CONCLUSION: BOT-8 offers an efficient and fast method for assessment of smell threshold, detection, memory, and identification in daily clinical practice. Disposable cotton swabs with odorants proved to be useful and safe during the COVID-19 pandemic.

QUALITY OF LIFE OF PATIENTS UNDERGOING REGULAR HEMODIALYSIS DURING THE COVID-19 PANDEMIC-A RETROSPECTIVE SINGLE-CENTRE STUDY

BACKGROUND AND AIMS: Patients on maintenance hemodialysis (HD) experience a heavy burden of the disease and frequently report poor quality of life (QoL) scores.[1,2] During the coronavirus 2019 (COVID-19) pandemic, additional challenges were posed to this vulnerable group. Restriction policies affected social contact and physical activity, even leading to intradialytic exercise programs' suspension.[3] Few studies analyze the impact of the pandemic on the QoL of this population. Thus, we aimed to assess the QoL of HD-dependent patients during the pandemic. METHOD: This is a retrospective single-center study. Demographic data originated from electronical medical records. The health-related QoL EQ-5D-5L questionnaire, developed by the EuroQol Group in 2005 and widely used for various diseases, was applied and assessed the five following self-reported scores: health (0-100 points), mobility (1-5 points), self-care (1-5 points), usual activities (1-5 points), pain/discomfort (1-5 points) and anxiety/depression (1-5 points).[4] With the exception of health, higher scores relate to greater difficulties, as inverted scales. Patients undergoing regular HD who filled in the questionnaire during the pandemic and at least one year prior were included. IBM® SPSS ® 27 software was used for statistical analysis. RESULTS: A total of 71 patients were included with a predominance of the male gender (54.9%). The median age was 77 years (IQR = 18 years) and the median time on HD was 78 months (IQR = 99 months). Thirty patients had diabetes (42.25%). During the pandemic, 12 patients (16.9%) had COVID-19. Analyzing the different QoL scores, no difference was reported concerning health (mean score 67.89 ± 18.3 versus 65.23 ± 20.6;T = 1.059, P = 0.297, IC (95%) = (-2.1;7.6);d = 0.126), usual activities (mean score 1.8 ± 1.09 versus 1.97 ± 1.32;T (71)= -1.136, P = 0.260, d = -0.135), pain/discomfort [mean score 1.8 ± 0.95 versus 2.07 ± 1.13;T (71) = -0.894, P = 0.260, d = -0.374], and anxiety/depression [mean score 1.8 ± 0.82 versus 1.94 ± 1.04;T (71) = -1.055, P = 0.295, d = 0.125] comparing with the pre-pandemic period. There was a statistically significant decrease in mobility (mean score of 1.96 ± 1.09 versus 2.44 ± 1.34) with moderate size effect [T (71) = -3.525, P < 0.001, d = -0.418]. There was also a statistically significant decrease in self-care (mean score of 1.45 ± 0.86 versus 1.82 ± 1.43) with small size effect [T (71) = -2.983, P = 0.004, d = -0.354). There were no differences in any score when adjusting to diabetes or COVID-19. CONCLUSION: During the pandemic, most QoL scores appear to have been unaffected. Higher resilience among these patients and the support from caregivers and healthcare professionals might have contributed to better coping during this period. Nonetheless, mobility seems to have become compromised and movement restrictions could have accelerated this process. Therefore, even in such times, promoting physical activity may play a role in improving the QoL of HD-dependent patients.

Healthcare-associated infections: a threat to the survival of patients with COVID-19 in intensive care units.

BACKGROUND: Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU). METHODS: This retrospective cohort study included patients with severe COVID-19 hospitalized in the ICU of four hospitals in the city of Curitiba, Brazil. Patients with COVID-19 who died during ICU hospitalization were compared with those who were discharged. A second analysis compared patients who developed HAI in the ICU with those who did not. Multiple logistic regression models were used to control for confounders. RESULTS: In total, 400 patients were included, and 123 (31%) patients developed HAI. The most common HAI was lower respiratory tract infection (67%). Independent risk factors for death were: age [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.43-2.15; P<0.0001]; clinical severity score (OR 2.21, 95% CI 1.70-2.87; P<0.0001); renal replacement therapy (OR 12.8, 95% CI 5.78-28.6; P<0.0001); and HAI (OR 5.9, 95% CI 3.31-10.5; P<0.0001). A longer interval between symptom onset and hospital admission was protective against death (OR 0.93, 95% CI 0.88-0.98; P=0.017). The only independent factors associated with HAI were high C-reactive protein and low PaO2/FiO2 ratio. CONCLUSIONS: No factors that could point to a high-risk group for HAI acquisition were identified. However, age, dialysis and HAI increased the risk of death in ICU patients with severe COVID-19; of these, HAI is the only preventable risk factor.