Monoclonal antibodies and oral pills for COVID-19: new possibilities for solid organ transplanted patients?

Since January 2020, the SARS-CoV-2 pandemic remains the leading health problem worldwide. In light of the use of DNA and RNA- based vaccines as a weapon to reduce the spread of the virus, an important question is the management of immunosuppressed patients such as those solid organ transplant recipients (SOTRs), who have not been included in the phase I-III clinical trials that considered immunosuppressive or immunodeficient state among main exclusion criteria during study subjects' enrollment. This is the reason for which there are currently no consolidated scientific data to support the safety and efficacy of nucleic acid-based vaccines in organ transplant patients. Furthermore, this population has a reduced humoral immune response to DNA and RNA vaccines compared to the immunocompetent counterpart, thus remaining at high risk for COVID-19. Another emerging problem is the reduced seroconversion to SARS-CoV-2 in transplant recipients. These patients appear to be less likely than immunocompetent patients to develop neutralizing antibodies postinfection. Therefore, the immune-compromised patients need to maintain strict precautions for COVID-19 even postvaccination, and other therapeutic and preventive tools such as monoclonal antibodies and oral antiviral pills should be considered as an additional strategy against the virus in these patients. Copyright © 2022 EDIZIONI MINERVA MEDICA.

Diagnostic delay due to COVID-19 pandemic: a case of uncontrolled growth of peripheral giant cell granuloma

COVID-19 pandemic had several consequences including reduced access to public health care service that led to significant delays in screenings, diagnosis, and treatments. Peripheral giant cell granuloma (PGCG) is a benign exophytic lesion of reactive nature, affecting gingiva and alveolar ridge. Recent studies report its highest prevalence in 5th-6th decade of age, occurring mainly in mandible with an average size of 1.3-1.7 cm. We aimed to show the impact of pandemic on diagnosis delay in a patient with peripheral giant cell granuloma that reached unusual dimensions. ACaucasian 61-year-old male referred to our observation for the presence of an exophytic lesion on edentulous alveolar crest of the mandible. He was an edentulous patient, that developed a lesion of unusual dimensions of 7x4.5x3.5 cm. The soft consistency, slow exophytic growth and bluish-red color suggested an inflammatory hyperplastic nature of the lesion. An excisional biopsy was performed in association with curettage of underlying periosteum. Histological examination revealed presence of spindle-shaped mononuclear cells and multiple multinucleated giant cells in a well vascularized stromal tissue. No calcifications were found. Clinical and histological features suggested the diagnosis of PGCG. This case is clinical evidence of the delays induced by the COVID-19 emergency, which negatively affected all health care and suggests that the PGCG, albeit benign in nature, may have an uncontrolled and non-self-limiting growth, making its surgical removing and healing process more complicated. Copyright © 2022 Edizioni Minerva Medica. All rights reserved.

Clinical manifestations of oral mucosa lesions in patients with SARS-CoV-2 infection

BACKGROUND: Due to Coronavirus disease, several body systems are involved, and, in the most severe cases, there may be a multiorgan disfunction. The general symptoms can be associated with lesions of the oral cavity. Among these the most reported are ulcerative lesions, together with vesicles and blisters, petechiae, and erythema multiforme-like lesions, aphthous-like lesions, herpetiform lesions and they typically appear at the same time as general symptoms or within one week. The aim of this study was to describe oral lesions observed in 41 Armenian patients with SARS-CoV-2 infection. METHODS: During the period of April 2020-January 2021, 43 patients aged 25 to 51 years positive for COVID-19 test were referred for a full oral mouth examination and diagnosis at Nord KS dental clinic. RESULTS: Of the 18 patients who were already diagnosed with SARS-CoV-2 infection at the time of the visit, 66.6% presented ulcerative lesions;in this group also Candida Albicans infection and lichenoid lesion were diagnosticated. 29 patients were suspected to be positive for COVID-19 and 23 tested positive. In this group of patient periodontal altera-tions relatable to hyperemia, gingival cyanosis and vascular dilation were the most frequently encountered manifesta-tions.CONCLUSIONS: Our study shows how the type of oral lesions during COVID-19 can be related to a determinate phase of the clinical progression: in the first stage of disease oral lesions could be an early sign of infection and during the full-blown phase of this disease they could be clinical manifestation of vasculitic and thrombotic phenomena responsible of COVID-19 complications. The role played by the oral examination in patients with COVID-19 is important in order to raise the suspicion of infection early and to monitor and improve the state of oral health and painful symptoms, in the event of the appearance of more disabling lesions.

Solid organ transplantation and SARS-CoV-2 vaccines: is there a possible alternative?

The spread of the SARS-Cov-2 virus has been a major public health problem for 2 years, especially for those immuno-suppressed patients such as those solid organ transplant recipients (SOTRs). DNA and RNA-based vaccines represent an excellent weapon to reduce the spread of the virus, but there are currently no consolidated scientific data to support the safety and efficacy of nucleic acid-based vaccines in organ transplant patients, having not been included in the phase I-III clinical trials that considered immunosuppressive or immunodeficient state among main exclusion criteria during study subjects enrollment. Solid organ transplant recipients have a reduced humoral immune response to DNA and RNA vaccines compared to the immunocompetent counterpart, thus remaining at high risk for COVID-19. Vaccines are consid-ered safe for all SOTRs, but there are in literature some reports of problems due to the vaccination in these patients such as episode of steroid-resistant acute cellular rejection and two cases of endothelial corneal allograft rejection following immunization. It is therefore essential that the immune-incompetent population continues to practice strict precautions for covid-19 even post vaccination and to keep in mind other therapeutic and preventive tools as an additional weapon against the virus.

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.

Evidence-based Recommendations on Periodontal Practice and the Management of Periodontal Patients During and After the COVID-19 Era: Challenging Infectious Diseases Spread by Airborne Transmission

Background: Periodontal care, which was completely suspended during the peak of the SARS-Cov-2 pandemic and was delayed and recurrently discontinued during the succeeding waves, must be safely provided in the COVID-19 era. Objectives: The study aimed to provide recommendations on periodontal practice, optimizing safety, ergonomics, and economic resources, and the management of periodontal patients, ensuring continuity, timing, and effectiveness of periodontal care in the COVID-19 era. Methods: Reported protocols for the dental practice in the context of the COVID-19 and current evidence on periodontitis treatment and prevention were reviewed. Results: Evidence-based recommendations on contamination control and ergonomic improvements for periodontal practice and the management of periodontal patients challenging COVID-19 and airborne infectious diseases have been provided. Conclusion: Due to the economic, ergonomic, and ethical concerns raised by limited periodontal care due to the SARS-Cov-2 pandemic, and awareness of other emerging airborne transmitted infections, the periodontal practice should integrate measures minimizing airborne cross-infections and optimizing time-space and economic resources. The management of periodontal patients in the COVID-19 era should comprise less complex treatments and more comprehensive and definitive approaches, reducing emergencies, session length and number, and, concurrently, extending the recall and maintenance intervals. Moreover, it should implement prevention strategies through teledentistry tools and apps, improving periodontal awareness and self-care, and also through the self-reporting of periodontitis and periodontal risk assessment tools, performing both "population-based" and "high-risk" surveillance of periodontitis. Finally, it should enhance inter-professional collaboration, through telehealth networks, especially targeting subjects at high-risk of both periodontitis and systemic disorders, each of the two variously linked to COVID-19 onset and worsening.