Alteration of the perception of cold, heat and texture of food in association with taste dysfunction in COVID-19

COVID19 is characterized by alteration of smell and taste perception. It was investigated the presence of alteration for cold, heat, and food consistency perception in COVID-19 patients and the possible correlation with the most commonly used biomarkers in a routine way (CRP, IL-6, IL-1, PSP, PCT) to show if the local inflammatory process may induce alteration of cold, heat, and food consistency perception in COVID-19. From March 2020 to April 2021, a survey about taste and oral tactile/thermal sensitivity dysfunction was carried out on 1155 patients with mild or moderate COVID-19, while patients admitted to intensive care were excluded because they could not answer questions from health professionals. Positive RT-PCR confirmed all diagnoses. CRP, IL-6, IL-1, PSP, and PCT were detected for each patient. Taste and Smell Questionnaire Section of the US NHANES 2011−2014 protocol (CDC 2013b) was used for gustatory function assessment. The study was approved by the Ethics committee of AOU Policlinico Consorziale di Bari (No. 6388 COVID19 DOM-protocol number 0034687/12-05-2020), and written informed consent was obtained. A total of 208 patients referred only to alteration to taste (208/821). 75/208 ageusia, 71/208 ipoageusia, 21/208 fantageusia, 19/208 dysgeusia, 22/208 parageusia. Significant correlations between CRP, IL-6, IL-1, PSP, PCT levels and type of dysfunctions about the perception of heat, cold and food consistency have not been found (P>0.05). Loss of taste can be due to the action of inflammatory mediators on gustatory buds, while alteration of cold, heat and food consistency perception may be due to direct damage of filiform papillae, allowing virus binding through the spike protein to ACE2 receptors of filiform papillae cells.

SARS-CoV-2 induced myocarditis: Current knowledge about its molecular and pathophysiological mechanisms

The existence of an inflammatory process in the heart muscle, related to a progressive worsening of myocardial function, different etiopathogenetic mechanisms concur and often overlap, thus making the diagnosis and the therapeutic approach complex. As the COVID-19 pandemic progresses, the effects of the disease on the organ systems and in particular on the cardiovascular system are becoming more and more profound. Cardiac involvement is a well-known event with a high percentage of findings in the heart's magnetic field, even in asymptomatic areas. There are numerous uncertainties regarding their evolution, in the long and short term, due not only to a difficult to determine the varied clinical expression and the rarely performed intramyocardial biopsy which additionally presents diagnostic problems but also in part to different clinical prognosis. Today, the new SARS-CoV-2 virus that uses the angiotensin converting enzyme 2 (ACE2) which is present at high levels in myocardial cells as its entrance it can create even severe heart injury. The pathophysiology in all of these cases can involve multiple immune and non-immune mechanisms within organs and vessels and can be occur in the clinical phases. Possible mechanisms of direct and indirect myocardial infarction in patients with COVID-19 include additional lesion and oxygen-rich and generalized inflammation response with myocardial immune hyperactivity (myocarditis). Therefore, these can occur through the excessive release of cytokines, the presence of thrombocytopenia, endocrine damage, heart failure, arrhythmias and more. Patients can show average signs of myocardial damage, and some develop spontaneous cardiac complications, such as heart failure, arrhythmias and, rarely, rare cardiogenic disorders. Pathophysiology in all of these may involve multiple mechanisms within the cytokine cephalic membrane, endocrine damage and thrombogenicity. The diagnosis of this myocardial injuri is mainly based on the myocardial enzyme troponin. This viewpoint paper explains today's knowledge on viral myocarditis, in particular that from SARS-CoV-2 infection, if there is a connection with other possible biomolecular pathogenetic factors that can influence its natural course. In fact, it is for this reason that the pathogenetic mechanisms are analyzed and described. At the same time, its possible interaction with other parameters that are documented risk factors for cardiovascular disease was examined. Although these biomolecular findings were mainly related to necrotic parts of the myocardium, it is important to recognize that myocardial damage early for a better approach and prognosis.

Evaluation of il-6 levels in covid-19 patients whit smell disorders

Smell dysfunction is one of the most frequent symptoms in COVID-19 patients. In the early stages of the disease it allows to identify positive subjects. The odorous substances recognize two different systems in the olfactory epithelium: the olfactory and the trigeminal systems that coexist and interact in the processing of sensory information. In COVID-19 patients there is an inflammatory reaction of the nasal mucosa. Infected supporting cells of the nasal mucosa release molecules that activate the local antiviral innate immune response. In fact, macrophages spread inflammatory mediators, in particular TNF-η , IL-6 and IL-1. In this study we compared IL-6 levels with the degree of olfactory disorders and with the type of unperceived odour.Materials and methodsFrom 15 March to 30 November 2020 have been selected 82 patients (45 men age 62.3 ±14.2 and 37 women age 57.1± 12.8) with only smell dysfunctions were divided into mild and moderate patients. The evaluation of the smell disorder was carried out with a 14 questionnaire relating to the perception of domestic odorous: 6 questions for olfactory sensitivity (own perfume usually sprayed, oregano, olive oil, nutella, coffee aroma, orange juice) and 8 for olfactory-trigeminal sensitivity (alcohol, fish odor, vinegar, mint (gum), toothpaste, shampoo, cheese, ammonia).The IL-6 (v.n. 0 - 7 pg/ml) was measured with chemiluminescence assay using Cobas e801 (Roche Instrumentation). Statistical analyses were performed with Wilcoxon Rank test, and Mann-Whitney test (p <0.05). ResultsThe trigeminal and olfactory sensitivity are more compromised in moderate than mild patients (p <0.05). The statistically significant differences there were in IL6 levels in moderate versus mild patients when there was an impairment of trigeminal sensitivity (p <0.05). Conclusion In this study suggested that the smell disorders in Covid-19 patients couldn't be a deficit of the olfactory central nervous pathways but could be rather than mainly associated with the inflammatory process of the nasal mucosa and that deficit of the type of domestic unperceived odour ('olfactory' or 'trigeminal' sensitivity) could indicate the degree of severity of the disease.

Endoscopy during the covid-19 pandemic: how to minimize the risks? a single outpatient centre experience

Aims All gastrointestinal endoscopic procedures have a high risk of aerosol contamination of the novel coronavirus to allhealthcare workers. For this reason, during the lockdown the health systems reduced all non-urgent endoscopic activities.On this second wave of the coronavirus disease 2019 (COVID 19) pandemic we cannot afford to suspend activities, as thehealth system is already overloaded. Our centre has continued regular endoscopic activity following a strict protocol toensure maximum safety for patients and for endoscopy staff. Methods Since October 2020 all patients requiring endoscopy examinations undergo a telephone triage two days before, which includes questions regarding body temperature, travel history, symptoms. In asymptomatic patients throat swabs forCOVID 19 nucleic acid polymerase chain reaction testing are collected the day before;for those with symptoms, endoscopyis postponed and they follow the protocols provided by our government as well as those who tested positive for the swab.During the endoscopy examination, endoscopy staff wear all personal protective equipment: surgical masks, face shields, disposable hats, shoe covers, gowns and gloves. Results In these two months, despite the exponential increase in infections, we ensured 20 endoscopies a day for 6 days aweek. 1040 patients have been subjected to our protocol: 12 were symptomatic, 5 were already aware of being Covid-19positive and they were in quarantine, 148 refused procedure for several reasons and 3 tested positive for the swab. To datewe have secured 83,8 % of our unit's full capacity and no endoscopy-related COVID-19 nosocomial infections have beenreported because of the strict execution of screening protocols. Conclusions Our experience shows that normal endoscopic activity can continue thanks to a strict screening procedures, ensuring the safety of patients and healthcare workers. It is also a way to screen all the population preventing the spread ofCOVID-19.

Vitamin D and Interleukine 6 evaluation in Covid-19 patients: Our experience

Background and aim. Coronavirus disease 2019 (COVID-19) is a viral pandemic that emerged from East Asia and quickly spread to the rest of the world due to Coronavirus 2 SARS-CoV-2. The clinical manifestations are accompanied by the onset of an inflammatory storm (cytokine release syndrome CRS). The key role in the cytokine storm is played by interleukin 6 (IL-6) owing to its robust pro-inflammatory function. It induces a variety of acute-phase proteins, increasing body temperature. Vitamin D signaling has emerged as a key regulator of immunity in humans. Studies have shown that Vitamin D, acting in an intracrine fashion, is able to induce expression of antibacterial proteins. The net effect of these actions is to support increased bacterial killing in a variety of cell types. Aim of this study was to evaluate the correlation between Vitamin D and IL-6 in patients with laboratory-confirmed COVID-19. Methods. 160 patients with laboratory-confirmed COVID-19 (85 males-median age 62y, and 75 female-median age 66y) were recruited (between March and may 2020). Patients did not require intensive care admission and they aren't in treatment with drugs Vitamin D homologous before the access to the hospital. Vitamin D (ng/ml) and IL-6 (pg/ml) were measured using chemiluminescence method on TGSTSTechno Genetics and Cobas e 8100-Roche respectively in three consecutive days. Statistical analysis was obtained using MedCalc software and p-value threshold of 5% was adopted. Results. Linear regression line: Y=121,16-0,98 (x);intercept 121,16 (95% CI =99,42 to 151.15, P<0.0001);slope =-0,98 (95% CI =-3,29 to-0,35, P<0.0001). Pearson correlation coefficient: R=-0.62 (95% CI=-0.71 to-0.33, P <0.0001) show a statistically significant inverse correlation. Conclusions. In Covid-19 patients, the increase of Vitamin D concentration, mainly in the third day, correlated to IL-6 lowering may be considered a signal of better clinical outcome of these patients. Further studies are needed to confirm the Vitamin D utility in Covid-19 patient management and to better explain its role in immunity response.

Correlation between Interleukin 6 (IL-6) and Human Epididymis Protein 4 (HE4) in Covid-19 patients: Two new potential biomarkers

Background and aim: Coronavirus disease 2019 (COVID-19) is a systemic illness, that recognizes the throat and nose as a gateway, due to Coronavirus 2 (SARS-CoV-2). In the lower respiratory tract, it is responsible of interstitial pneumonia developing into a severe acute respiratory distress syndrome. Human Epididymis Protein 4 (HE4) is present in many normal human tissues but also in the affected tissue of the SARSCoV-2 (oral cavity tissue, nasopharynx, respiratory tract). Many studies have shown the presence of HE4 in the lining fluid of the airway surface, secreted by the submucous glands. Its function is not fully clarified but HE4 seems to play an important role in the immune defense. Instead, in the bloodstream of COVID-19 patients, Interleukin 6 (IL-6) is the main inflammatory cytokine with a key role in the inflammatory storm (cytokine release syndrome, CRS) that accompanies the clinical onset of COVID-19 and thus represents a valid biomarker of the acute phase. Aim of this study was to evaluate the correlation between HE4 and IL-6 concentrations in patients with laboratory-confirmed COVID-19. Methods: 190 patients with laboratory-confirmed COVID-19 (115 males-median age 65y, and 75 female-median age 67y) were recruited (between March and May 2020). Patients did not require intensive care admission and they had no diagnosis of ovaric tumor, lung tumor and renal and/or lung fibrosis. HE4 (pmol/L) and IL-6 (pg/mL) were measured using chemiluminescence method by Architect i1000SR (Abbott) and Cobas e8100 (Roche) respectively in three consecutive days. Statistical analysis was obtained using MedCalc software and a p-value threshold of 5% was adopted. Results: Linear regression line: Y=11,87(x) + 78,16;intercept 11,87 (95% CI=7,22 to 16,21;P<0,05);slope=78,16 (95% CI=34,41 to 96,22;P<0,05). Pearson correlation coefficient: R=0.58 (95% CI=0,25 to 0,66;P<0,05) shows a statistically significant correlation. Conclusions: Based on our results, HE4 could play an important role in the inflammatory response in COVID-19 patients and it could be used as a potential biomarker with IL-6 in the management of patient COVID-19. Further studies are needed to confirm the usefulness of the HE4 assay and to better explain its possible role in the immune response.