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1.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P159, 2022.
Article in English | EMBASE | ID: covidwho-2064479

ABSTRACT

Introduction: Anatomic assessment of the upper airway remains important in directing and monitoring of care for patients with obstructive sleep apnea (OSA). Nasopharyngoscopy is routine in clinical practice, but it can be invasive and potentially less attractive in the post-COVID-19 care setting. It also only allows subjective assessment. Ultrasound imaging of the upper airway with backscattered imaging analyzed via machine learning algorithm is investigated as a potential alternative. Method(s): Sixty-three subjects (14 female) with a mean age of 39.4 (12.6) years, body mass index (BMI) of 26.4 (4.6) kg/m2, and apnea-hypopnea index (AHI) of 19.0 (16.1) were consented from Stanford sleep surgery (July 2020 to May 2021). A standardized ultrasound protocol was used to image the soft palate, oropharynx, tongue base, and epiglottis. Via ultrasound device cleared by US Food and Drug Administation, backscattered ultrasound imaging (BUI) of the upper airway was performed and analyzed with machinelearning algorithms. Combined with B-mode measurements of airway muscular cross-sections, a logistic regression model was built to correlate with OSA severity. Result(s): The BUI of subjects with mild OSA was different from moderate-severe (AHI>=15) OSA at the soft palate (P=.0007). The axial-to-lateral ratio of upper airway length was reduced in the lower soft palate of the moderate-severe group (P=.0207). The logistic regression model with BUI, axial-to-lateral ratio at the soft palate, and BMI showed an area under the receiver-operating characteristic curve of 0.84 (95% CI, 0.726-0.920) in moderate-severe OSA. Conclusion(s): A noninvasive yet replicable technique to visualize and phenotype the upper airway is critical in the management of patients with sleep-disordered breathing. Sonographic BUI combined with B-mode airway measurements analyzed by machine learning show promise in characterizing the upper airway in patients with moderate-severe OSA.

2.
Emergency Medicine Journal : EMJ ; 39(10):e9, 2022.
Article in English | ProQuest Central | ID: covidwho-2064194

ABSTRACT

Kawasaki disease Scarlet fever Multisystem inflammatory syndrome in children (MIS-C) Hand, foot and mouth disease (coxsackievirus) For answer see page 02 For question see page 01 Answer: C Multisystem inflammatory syndrome in children (MIS-C) was highly suspected because of the biological inflammatory syndrome and the Kawasaki-like dermatological presentation. Majority of published cases have positive serologic testing for SARS-CoV-2 (67%) and less commonly positive RT-PCR testing from nasopharyngeal testing (33%),2 suggesting that the pathogenesis of this syndrome involves post infection immune dysregulation rather than related to acute early infection.2 3 This affliction is life-threatening as it is usually associated with severe physiological impairment (hypotension, tachycardia) requiring admission in an intensive care unit in more than 50% of cases. Multi-System inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management.

3.
Clinical Toxicology ; 60(Supplement 2):6-7, 2022.
Article in English | EMBASE | ID: covidwho-2062726

ABSTRACT

Background: In New Mexico from 2013 to 2017, Native Americans had the highest number of poison-related deaths (26.6/100,000 population) when compared to other ethnic groups: Hispanics (26.5/100,000), Black/African Americans (24.4/ 100,000), Whites (21.2/100,000), and Asian/Pacific Islanders (4.7/ 100,000). In addition, the poison center has traditionally experienced low call volumes from tribal communities. A survey conducted in 2018 revealed that community health representatives of the Navajo Nation reported that their respective communities preferred printed materials and radio public service announcements (PSAs) as platforms to receive educational messages. Method(s): In 2021, a radio public service announcement (PSA) was developed in English and translated into Dine by a college of pharmacy student and a medical doctor, both fluent in their native tongue. The PSAs provide examples of poisoning scenarios and advises to call the poison hotline at the end. Thirty second versions of both the English and Dine PSAs were run on the Navajo Nation internet radio station, KTNN, for the month of September 2021, and then again for the month of March 2022. Both interventions had an equal amount of radio spots. Result(s): Data were retrieved from Toxicall for zip codes that corresponded to the Navajo Nation in New Mexico. COVID calls were excluded from the data. Calls stemming from a poisoning outbreak that occurred on the Navajo Nation during the summer of 2020 were also eliminated to account for atypical patterns in call volume. There was a 48.3% increase in calls when comparing September 2021, intervention month, to September 2020. The March 2022 intervention showed a 54.5% uptick in calls when compared to March 2021. Both the September and March interventions resulted in an increase of 30 calls. To control for March also being poison prevention month in New Mexico, Navajo Nation zip codes were excluded, and then the total calls for the rest of the state were calculated. This resulted in 2147 calls in 2021 and 2073 in 2022. Conclusion(s): The significant increase in call volumes when comparing the intervention months to the preceding years, strongly suggests that radio PSAs increase poison hotline traffic. Both intervention months showing an increase of 30 calls was also striking. In addition, total calls for the state without including the Navajo Nation zip codes dropped from March 2021 to March 2022, further eliminating poison prevention month as a cofactor in the increase in calls during the March intervention. Due to the consistent decrease in calls to poison centers across the nation, it is imperative to continue investigating how certain dynamics influence call volume, such as increasing internet consumption and, perhaps, the COVID 19 pandemic. It is equally necessary to research other at-risk communities to refine the components of effective communication and to define relevant platforms for delivering those educational messages.

4.
Chest ; 162(4):A1102, 2022.
Article in English | EMBASE | ID: covidwho-2060769

ABSTRACT

SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: More reports are indicating a temporal association between Bell's palsy and the mRNA vaccine for coronavirus disease 2019 (COVID-19). Therefore, collecting vaccine history is becoming important in post-marketing surveillance to monitor the safety of vaccines in real-world settings. We report the case of concomitant occurrence of Bell's palsy and glossopharyngeal neuralgia leading to severe symptomatic hyponatremia in a previously healthy patient. CASE PRESENTATION: A 60 year-old-female without significant medical history presented to the hospital with odynophagia, and generalized weakness for two weeks. She decreased her oral intake due to stabbing pain in the back of her throat triggered by swallowing. She reported hyperacusis and frequent shooting pain in the left cheek managed with non-steroidal anti-inflammatory drugs. The symptoms occurred several days after the first dose of the mRNA vaccine for COVID-19. She denied previous COVID-19 infection and herpes zoster. Examination revealed dry mucosa, left facial muscle weakness, inability to raise the left eyebrow or lift the labial commissure, effacement of the nasolabial fold, and left-sided frontal wrinkles. Laboratory investigation revealed sodium of 110. Computerized Tomography of the brain revealed negative findings for intracranial abnormalities. Severe symptomatic hyponatremia was managed with hypertonic saline. The neurologist made the diagnosis of Bell's palsy and glossopharyngeal trigeminal neuralgia leading to poor oral intake. We initiated acyclovir, prednisone, and gabapentin. The patient recovered from hyponatremia and experienced improvement of neurological symptoms with initiated medications. DISCUSSION: High morbidity and mortality of patients with COVID-19 accelerated the development and production of the vaccines. During the pandemic, mRNA COVID-19 vaccines reduced asymptomatic and prevented severe symptomatic COVID-19 infection and its complications. Although the benefits and protective effects of the COVID-19 vaccines outweighed the risks associated with them, we have reports of associations between vaccines and certain disorders such as Bell's palsy. Glossopharyngeal neuralgia is defined as sudden severe brief pain in the distribution of the glossopharyngeal nerve. It can be described as transient stabbing pain experienced in the ear, tonsillar fossa, and base of the tongue. Unusual presentation is fear to eat as this can be a precipitating cause of the pain. It overlaps with trigeminal neuralgia and can create a diagnostic dilemma. CONCLUSIONS: In summary, it is unknown what causal relationship exists between the mRNA COVID-19 vaccine and neurological diseases such as Bell's palsy and glossopharyngeal neuralgia. Glossopharyngeal neuralgia is frequently overlooked as a diagnosis. This is a unique case of concomitant glossopharyngeal neuralgia and Bell's palsy that is coincidental with a history of COVID-19 vaccine. Reference #1: El Sahly HM, Baden LR, Essink B, et al. Efficacy of the mRNA-1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase. New England Journal of Medicine. 2021;385(19):1774-1785. doi:10.1056/NEJMoa2113017 Reference #2: Singh PM, Kaur M, Trikha A. An uncommonly common: Is glossopharyngeal neuralgia. Ann Indian Acad Neurol. 2013;16(1):1-8. doi:10.4103/0972-2327.107662 Reference #3: Cellina M, D'Arrigo A, Floridi C, Oliva G, Carrafiello G. Left Bell's palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: A case report. Clin Imaging. 2022;82:1-4. doi:10.1016/j.clinimag.2021.10.010 DISCLOSURES: No relevant relationships by Nemanja Draguljevic No relevant relationships by Katherine Hodgin No relevant relationships by Kristina Menchaca No relevant relationships by Catherine Ostos Perez

5.
Chest ; 162(4):A316, 2022.
Article in English | EMBASE | ID: covidwho-2060562

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Macroglossia is a rare but life-threatening symptom that disrupts a person's ability to talk, swallow, and can also compromise their airway. Although not very well studied, there are several case reports describing a possible association between COVID-19 infection and macroglossia in people with African ancestry. We present an African American man who developed significant macroglossia several days after testing positive for COVID-19. CASE PRESENTATION: A 59 y/o African American male with a history of chronic bronchitis and tobacco use presented with 4 days of dyspnea. Sars-Cov-2 PCR was positive. Chest x-ray revealed bilateral, diffuse lung infiltrates. He had an elevated CRP of 295 and a d-dimer of 265. He became lethargic and hypercapnic requiring intubation which was nontraumatic. He was sedated, paralyzed, and proned. He received steroid therapy, broad spectrum antibiotics and a dose of Sarilumab. About a week later, he developed macroglossia that worsened over the course of days. Side effect profiles of each of his medications did not reveal any increased likelihood of macroglossia. C1Q complement cascade was mildly elevated and C1 esterase inhibitor level was normal. Diagnosis and treatment was necessary at this point as concerns for tongue central necrosis were raised and baseline tongue size would be required for proper evaluation and surgical intervention if necessary. He was given 4 units of FFP for possible angioedema with no improvement. CT Neck W/ contrast revealed edema and protrusion of the tongue without a discrete mass. Workup for acromegaly, sarcoidosis, amyloidosis, and hypothyroidism were negative. A pressure ulcer developed on his tongue due to the endotracheal tube and so he underwent tracheostomy. His tongue was draped in Chlorhexidine soaked gauze as well as Vashe wound solution. As he recovered from COVID-19 pneumonia, his respiratory status improved as well as his macroglossia. His tracheostomy was decannulated and his tongue returned to its baseline size. DISCUSSION: Macroglossia can lead to complications including airway compromise, dysphagia, or speech difficulties. It has been heavily proposed in the literature that COVID-19 infection can lead to postinfectious inflammatory peripheral nerve injury secondary to immune driven mechanisms. It was also previously proposed in literature based on immune-histochemical analysis of a tongue tissue sample taken from a COVID-19 patient that tongue muscle atrophy occurs as well as macrophage infiltration similar to that of nerve injury repair which can eventually lead to macroglossia. CONCLUSIONS: As the effects of COVID-19 are becoming better studied overtime, macroglossia, especially in those with African ancestry, is increasingly coming under the radar. This case report seeks to educate clinicians on this possible sequela and encourage supportive treatment in hopes that the tongue will recover. Reference #1: McCrossan S, Martin S, Hill C. Tongue Reduction for Macroglossia. J Craniofac Surg. 2021;32(5):1856-1859. doi:10.1097/SCS.0000000000007276 Reference #2: Colombo D, Del Nonno F, Nardacci R, Falasca L. May macroglossia in COVID-19 be related not only to angioedema?. J Infect Public Health. 2022;15(1):112-115. doi:10.1016/j.jiph.2021.10.026 Reference #3: Fernandez CE, Franz CK, Ko JH, et al. Imaging Review of Peripheral Nerve Injuries in Patients with COVID-19. Radiology. 2020;298 (3). https://doi.org/10.1148/radiol.2020203116 DISCLOSURES: No relevant relationships by Megan Devine No relevant relationships by Devin Haney No relevant relationships by Es-Haq Hassanin No relevant relationships by Nadim Islam No relevant relationships by Alyssa Weyer

6.
BMC Microbiol ; 22(1): 214, 2022 09 09.
Article in English | MEDLINE | ID: covidwho-2038660

ABSTRACT

BACKGROUND: Tongue coating is an important health indicator in traditional Chinese medicine (TCM). The tongue coating microbiome can distinguish disease patients from healthy controls. To study the relationship between different types of tongue coatings and health, we analyzed the species composition of different types of tongue coatings and the co-occurrence relationships between microorganisms in Chinese adults. From June 2019 to October 2020, 158 adults from Hangzhou and Shaoxing City, Zhejiang Province, were enrolled. We classified the TCM tongue coatings into four different types: thin white tongue fur (TWF), thin yellow tongue fur (TYF), white greasy tongue fur (WGF), and yellow greasy tongue fur (YGF). Tongue coating specimens were collected and used for 16S rRNA gene sequencing using the Illumina MiSeq system. Wilcoxon rank-sum and permutational multivariate analysis of variance tests were used to analyze the data. The microbial networks in the four types of tongue coatings were inferred independently using sparse inverse covariance estimation for ecological association inference. RESULTS: The microbial composition was similar among the different tongue coatings; however, the abundance of microorganisms differed. TWF had a higher abundance of Fusobacterium periodonticum and Neisseria mucosa, the highest α-diversity, and a highly connected community (average degree = 3.59, average closeness centrality = 0.33). TYF had the lowest α-diversity, but the most species in the co-occurrence network diagram (number of nodes = 88). The platelet-to-lymphocyte ratio (PLR) was associated with tongue coating (P = 0.035), and the YGF and TYF groups had higher PLR values. In the co-occurrence network, Aggregatibacter segnis was the "driver species" of the TWF and TYF groups and correlated with C-reactive protein (P < 0.05). Streptococcus anginosus was the "driver species" in the YGF and TWF groups and was positively correlated with body mass index and weight (P < 0.05). CONCLUSION: Different tongue coatings have similar microbial compositions but different abundances of certain bacteria. The co-occurrence of microorganisms in the different tongue coatings also varies. The significance of different tongue coatings in TCM theory is consistent with the characteristics and roles of the corresponding tongue-coating microbes. This further supports considering tongue coating as a risk factor for disease.


Subject(s)
Microbiota , Tongue , Adult , Bacteria/genetics , Humans , Medicine, Chinese Traditional , Microbiota/genetics , RNA, Ribosomal, 16S/genetics , Tongue/microbiology
7.
Annals of Clinical Psychiatry ; 34(3):10-11, 2022.
Article in English | EMBASE | ID: covidwho-2030804

ABSTRACT

BACKGROUND: Self-mutilating behavior in the pediatric population is associated with psychiatric and psychosocial factors. Autosarcophagy, or self-cannibalism, is an extremely rare form of self-mutilation and is predominantly seen with psychosis or substance use.1 We report a case of oral autosarcophagy in a pediatric patient in the absence of substance use or psychosis. OBJECTIVE: To learn about autosarcophagy and its treatment in the pediatric population and to explore other neuropsychiatric disorders in which it is a predominant manifestation. METHODS: Review of a case using electronic medical records and relevant literature. Key terms: 'autosarcophagy,' 'body focused repetitive behavior,' 'oral self injury,' 'pediatric self-mutilation' using Medscape and Google Scholar. RESULTS: We present a 14-year-old female with history of seizure disorder in full remission, depression, self-cutting behavior, and suicidal ideation with 2 psychiatric hospitalizations, who presented to the pediatric emergency department with oral bleeding after eating one-third of her tongue over the course of a month. Evaluation was notable for poverty of speech and constricted affect. Patient stated she was 'trying to remove an infection' and alleviate discomfort. She denied that this behavior was an attempt to end her life but endorsed past suicidal ideations and cutting behavior. History revealed emergency room evaluation for aggressive behavior and episodes of volitional enuresis. We diagnosed major depressive disorder, recurrent episode in remission without psychosis. Drug screen, complete blood count, complete metabolic panel, COVID-19, urinalysis, thyroid-stimulating hormone, head computed tomography, and beta-human chorionic gonadotropin were negative. Patient continued home oral medications aripiprazole 10 mg daily, fluoxetine 30 mg daily, and levetiracetam 500 mg twice daily and was discharged the next day. CONCLUSIONS: Self-harm is observed in 17.2% of adolescents, 13.4% of young adults, and 5.5% of older adults.2 Cases of self-mutilation in pediatric patients typically present as cutting, burning, or head banging.3 Our differential diagnoses include borderline personality disorder due to repeated impulsivity and self-harm, and body focused repetitive behavior disorder (obsessive-compulsive disorder-related disorder), which presents with repetitive strain injuries and dental malocclusions. Treatment of self-mutilation involves treating the underlying psychiatric condition with psychotropic medications.4,5 In pediatric patients, dialectical behavioral therapy has been shown to reduce parasuicidal behaviors after 1 year of therapy.6 Our patient, under constant 24-hour observation, was cleared by medical, psychiatric, and dental teams. The patient followed up with outpatient psychotherapy and psychiatry. We are presenting this rare case for clinicians to identify and manage pediatric patients presenting with unique forms of self-harm tendencies.

8.
J Indian Soc Periodontol ; 26(5): 498-500, 2022.
Article in English | MEDLINE | ID: covidwho-2024751

ABSTRACT

Since the advent of the coronavirus disease (COVID-19) infection, this highly infectious virus has spread worldwide infecting millions of people. Not only it has affected the pulmonary function of the body, leading to difficulty in breathing, but at the same time, an array of other systemic infections which may or may not be directly due to coronavirus infection, due to an absent established relationship. The mucocutaneous manifestations seen in COVID-19 infection include depapillation of the tongue, lesions seen on alveolar mucosa, gingiva, buccal mucosa, dysgeusia, and dry mouth. This case report highlights the effect of COVID-19 on the tongue also known as COVID tongue seen as depapillation of the tongue surface. Due to the absence of long-term studies and time-limited research, a direct relationship between COVID-19 and the systemic manifestation is not yet established. More research has to be done in this direction, to chart out the exact etiology of these systemic infections.

9.
J Clin Biochem Nutr ; 71(2): 129-135, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2022551

ABSTRACT

COVID-19 is pandemic since 2020 and further information is necessary on the risk factors associated with the infection of SARS-CoV-2. As an entry mechanism, SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as receptor and transmembrane serine protease 2 (TMPRSS2) to activate fusion with host plasma membrane. Because dysgeusia is an early symptom of COVID-19, we here studied the expression of ACE2 and TMPRSS2 in the tongue and the associated tissues of mice and humans with immunohistochemistry and immunoblot analysis. ACE2 expression was low in the human tongue but was observed in the squamous epithelium, perineurium, arterial wall, salivary glands as well as taste buds. In contrast, mice showed high expression. In sharp contrast, TMPRSS2 expression was high in all the cells mentioned above in humans but relatively low in mice except for salivary glands. We then performed semi-quantitation of immunohistochemistry data of human ACE2 and TMPRSS2 and analyzed for age, sex, alcohol intake, and smoking habit with logistic regression analysis. We found that alcohol intake and female gender were the significant risk factors for increasing TMPRSS2 expression. In conclusion, TMPRSS2 is an important factor to be considered regarding SARS-CoV-2 entry and amplification in the oral cavity, which is promoted through drinking habit.

10.
International Journal of Medical Engineering and Informatics ; 14(5):379-390, 2022.
Article in English | ProQuest Central | ID: covidwho-2022020

ABSTRACT

Due to the spread of COVID-19 all around the world, there is a need of automatic system for primary tongue ulcer cancerous cell detection since everyone do not go to hospital due to the panic and fear of virus spread. These diseases if avoided may spread soon. So, in such a situation, there is global need of improvement in disease sensing through remote devices using non-invasive methods. Automatic tongue analysis supports the examiner to identify the problem which can be finally verified using invasive methods. In automated tongue analysis image quality, segmentation of the affected region plays an important role for disease identification. This paper proposes mobile-based image sensing and sending the image to the examiner, if examiner finds an issue in the image, the examiner may guide the user to go for further treatment. For segmentation of abnormal area, K-mean clustering is used by varying its parameters.

11.
Indian Journal of Critical Care Medicine ; 26:S51-S52, 2022.
Article in English | EMBASE | ID: covidwho-2006347

ABSTRACT

Introduction: Macroglossia is defined as an enlargement of the tongue in the resting position, protruding beyond the teeth. Many cases have been reported secondary to patient positioning while under anesthesia, post oro-pharyngeal packing, trauma or surgery, and allergic or non-allergic angioedema. However, acute macroglossia in the ICU is a rare situation. In COVID-19 related severe ARDS, endotracheal intubation and prolonged proning is an important part of management of hypoxemic respiratory failure Prone positioning also has the potential to independently cause macroglossia. Awareness of this complication of proning could help mitigate morbidity in patients. Case report: A 53-year-old diabetic, hypertensive overweight female with OSA presented with progressive shortness of breath and productive cough. She was mechanically ventilated in ICU in view of respiratory distress secondary to COVID-19 pneumonia. Intubation was minimally traumatic with minimal oral bleeding settling over few minutes. Though managed with medications as per COVID-19 management protocol, she progressed to severe ARDS hence proned on hospital day 1 for 16 hours - PaO2/FiO2 ratio improved. She was not proned further. Acute macroglossia (3 inches outside the oral cavity) with lower facial edema was noted 4 days post proning. Saline moistened gauze was loosely wrapped around the tongue every hour. Circumferential ecchymosis was noticed around her neck on the 6th day. On day 8, macroglossia did not show signs of resolution. Hence, the tongue was pushed in manually every 2 hourly and the position was maintained manually for 10 minutes. The swelling decreased gradually with the tongue staying in a retracted position on treatment day 2. On day 3, there was a complete resolution of the swelling. However, she had persistent swallowing difficulty causing difficulty in weaning from tracheostomy. MRI of neck and chest showed large pre-vertebral collection from the upper border of C2 inferiorly across the thoracic inlet to the posterior mediastinum with thin linear extension up to the lower border of T4. Mass effect with airway compression, displacement, and compression of esophagus and neck vessels was seen. Trans-oral exploration revealed mucosal rent and bulge in the posterior pharyngeal wall. The hematoma was evacuated by ENT specialists. She was discharged on tracheostomy and feeding tube. Tracheostomy decannulation was done after 1 month. Discussion: In our practice of proning patients with ARDS for >10 years, this is the first case of macroglossia as a complication of proning that we encountered. Other factors that could have contributed to this patient are obesity and mildly traumatic intubation. Development of macroglossia 4 days after proning and resolution over a short period of time is rare and suggests lymphatic and vascular compression as the cause. Later development of ecchymosis and dysphagia may be due to the posterior pharyngeal injury. Conclusion: Proning, especially in obese patients, can be a challenge. Positioning of the face and avoidance of injury to any of the structures is vital to the care of the proned patient. Medical staff involved in patient care should be aware and vigilant to pick up this condition early to avoid further injury.

12.
J Stomatol Oral Maxillofac Surg ; 2022 Aug 28.
Article in English | MEDLINE | ID: covidwho-2004271

ABSTRACT

OBJECTIVE: The objective of this study was to determine if patients with Neurofibromatosis Type 1 (NF1) have an impaired sense of smell or taste. Neurofibromin, the NF1gene protein product is ubiquitous in the body and is especially associated with the development of neurogenetic structures. Lately enlarged olfactory bulbs have been described in patients with NF1. Until now, there is no study to evaluate the sense of smell and taste in patients with NF1. METHOD: This study has been approved by the Hamburg Ethics committee. An evaluation of the sense of smell and taste was undertaken in 26 patients with NF1 using the Burghart Sniffin' Sticks. Three patients were excluded due to a prior infection with the Corona virus. As a control group the same examination was performed in healthy individuals (same sex/ same age as the NF1 patients) by the same examiner. RESULTS: The results show a normal sense of smell in patients with NF1. The morphologic finding of enlarged olfactory bulbs seem to have no functional equivalent. However, 8 out of 23 patients with NF1 had difficulties identifying at least one taste flavor. In total 9.8% of possible taste qualities were misidentified. In the healthy control group, all taste qualities were identified correctly. Considering each taste quality as separate case, a significant difference in the taste function was identified based on Fisher's exact test (p=0.003). CONCLUSION: The current study does not show a correlation between NF1 and an impaired sense of smell. Yet significant reduction in the sense of taste was found in the patients with NF1. Further research will have to be conducted to find the underlying causal pathways. CLINICAL RELEVANCE: NF1 is recently being acknowledged not only for its' macroscopic aesthetic and functional impairments, but also as a neurodevelopmental disorder. Evaluating the neural structures in regard to their function is a first step in understanding more about the disease.

13.
Journal of General Internal Medicine ; 37:S507, 2022.
Article in English | EMBASE | ID: covidwho-1995871

ABSTRACT

CASE: A 22-year-old woman with h/o asthma initially presented to the hospital with lip swelling and sore throat. She tested positive for COVID-19 and received a casirivimab-imdevimab (monoclonal antibody) infusion. She returned a week later with worsening lip swelling, dysphagia and conjunctivitis. Physical exam revealed edematous lips with vesicular lesions, no tongue swelling, tonsillar exudate, 4+ conjunctival injection bilaterally with purulent discharge, and shallow clean based clitoral ulceration. She reports no history of allergic reactions, angioedema or exposure to new medications. Nasopharyngolaryngoscopy showed no laryngeal edema but visualized exudates throughout the supraglottis and glottis. C4, ANA, CMV, EBV, throat and blood cultures were negative. STI testing was trichomonas positive and gonorrhea/chlamydia negative. Respiratory virus panel remained positive for COVID-19. HSV swab of lip lesion, HSV 1/2 IgG and IgM were negative. Mycoplasma pneumoniae IgG was elevated (0.60, negative is ≤0.09), IgM equivocal (0.85, negative is ≤0.76), and nasopharyngeal PCR negative. Conjunctival culture showed rare bacteria (S. Aureus) and no leukocytes. She initially received methylprednisolone IV due to concern for angioedema, acyclovir for empiric HSV treatment and empiric antibacterial moxifloxacin eye drops. Given lack of infectious trigger, her presentation was concerning for reactive infectious mucocutaneous eruption (RIME) associated with SARSCoV-2 or Mycoplasma. Prednisone 1mg/kg daily was initiated followed by improvement in oral mucositis and conjunctivitis within days. IMPACT/DISCUSSION: A broad differential is important when evaluating oral swelling and mucositis. Her lack of cutaneous involvement, medication exposure or family history and negative infectious, autoimmune and inflammatory workup make other causes including Stevens-Johnson syndrome, erythema multiforme, angioedema, and HSV less likely. Our final diagnosis of RIME describes mucocutaneous eruptions likely due to an immune response triggered by bacterial or viral infection. Our patient's RIME may be due to COVID-19 or Mycoplasma given her equivocal Mycoplasma IgM. Eruptions generally involve two or more mucosal sites and occur mostly in children and adolescents. Common presentations include oral erosions and ulcers, purulent bilateral conjunctivitis, or urogenital lesions, which were all seen in our patient. As this is a relatively rare and new condition, no standard of care treatment exists for RIME but systemic steroids have been effective in case reports for initial treatment and subsequent flares. CONCLUSION: RIME is a rare, newly described condition in young patients who develop postinfectious mucocutaneous eruptions of two or more mucosal sites. It has been recently reported in association with COVID-19 and its association with Mycoplasma infection is important to evaluate. This condition is important to recognize and treat given the requirement for higher dose steroids than that used for angioedema.

14.
Journal of General Internal Medicine ; 37:S362, 2022.
Article in English | EMBASE | ID: covidwho-1995661

ABSTRACT

CASE: Our patient is a 52-year-old female with a history of gastroesophageal reflux and hypertension. 36 hours after receiving the second Pfizer COVID-19 vaccine, she developed lip and tongue swelling, mucosal ulcerations, and respiratory distress. There was no conjunctivitis or genital involvement. She denied taking any new medications, supplements, or food that might have led to the reactions. She initially presented to an outside hospital and required intubation prior to transfer to our facility. A bedside esophagogastroduodenoscopy (EGD) was performed noting extensive Grade D erosive esophagitis and gastric ulcerations with friability. When the endoscope was removed a 34cm section of necrotic esophageal tissue was removed from the airway. Despite intravenous steroid treatment, she continued to have esophageal scarring and was unable to tolerate food by mouth. Therefore, a gastrostomy tube was placed. Since that time, she has required several recurrent EGDs for esophageal dilation due to scarring. It has now been six months from her initial injury, and unfortunately, the patient is still unable to take PO and is dependent on tube feedings. IMPACT/DISCUSSION: The coronavirus pandemic began in December 2019. At the time of this report, SARS-CoV-2 infection has been the cause of 5.48 million deaths worldwide and 836,000 deaths in the United States alone. In addition, this global pandemic has had severe economic and social implications. There are currently three vaccines authorized by the United States Food and Drug Administration for emergency use. I report an extremely uncommon complication of the Pfizer COVID-19 vaccine: a case of Eryethema Multiforme Major that occurred after the second dose vaccine without exposure to any other drug. Eryethema Multiforme is divided into major and minor forms and is regarded as distinct from Stevens- Johnson syndrome and toxic epidermal necrolysis. It is related to infections, usually Herpes Simplex Virus, or less commonly, to medications. In Erythema Multiforme, mucous membrane involvement is absent or mild. Erythema Multiforme Major is an immune mediated skin reaction involving the oral cavity and mucosa that is serious and occasionally life threatening. There have been several reported cases of Erythema Multiforme following COVID-19 vaccination but only one other cases of Erythema Multiforme Major associated with the mRnA-1273 SARS-CoV-2 vaccine (Moderna.) CONCLUSION: This case highlights an extremely rare vaccine consequence. The benefits still greatly outweigh the risks of vaccination, and this case does not diminish the importance of COVID-19 vaccination to effectively control this pandemic.

15.
Int J Environ Res Public Health ; 19(15)2022 07 24.
Article in English | MEDLINE | ID: covidwho-1994028

ABSTRACT

BACKGROUND: BMS is a chronic pain syndrome affecting the oral mucosa. It consists of experiencing a burning or dysesthetic sensation. BMS prevalence varies, with up to 15% among women. An effective treatment is still unattainable. MATERIAL AND METHODS: A total of 60 patients with BMS qualified for a randomised trial, divided in two groups: the clonazepam-treated and tongue protector group. Treatment was provided for 4 weeks in both groups. In the former, the oral dosage of clonazepam 0.5 mg; in the latter, a tongue protector was used. Clinical oral examination was performed, and the presence of taste disorder and pain intensity, on the visual analogues scale, were recorded. Psychological domains were explored with the Beck depression inventory (depression), Athens insomnia scale (insomnia), Eyesenck personality questionnaire-revised (personality traits), and WHO quality of life questionnaire (quality of life). RESULTS: Complete recovery was observed in three patients after clonazepam and one patient after tongue guard treatment. A greater improvement in the VAS scores, from baseline to the control values, was demonstrated in the clonazepam group, and it was statistically significant. In women, the level of depression significantly correlated with all domains of quality of life. CONCLUSIONS: BMS is an ongoing multi-specialist challenge. The development of new pathophysiological concepts of BMS offers hope for more effective treatment. Considering the influence of BMS on the quality of life and mental disorders in most patients, further research on the possibilities of therapy seems to be very important.


Subject(s)
Burning Mouth Syndrome , Sleep Initiation and Maintenance Disorders , Burning Mouth Syndrome/diagnosis , Burning Mouth Syndrome/drug therapy , Burning Mouth Syndrome/psychology , Clonazepam/therapeutic use , Female , Humans , Quality of Life , Tongue
16.
IEEE Transactions on Medical Robotics and Bionics ; : 1-1, 2022.
Article in English | Scopus | ID: covidwho-1985504

ABSTRACT

Oropharyngeal swab sampling is the major viral nucleic acid detection method to diagnose COVID-19. Medical staff exposes themselves to the respiratory secretions of patients, which makes them vulnerable to infection. To protect medical staff, we summarize the clinical requirements for robot into five considerations (standardization, ergonomics, safety, isolation, and task allocation) and developed a remotely operated oropharyngeal swab sampling robot. With robot assistance, spatial isolation between medical staff and the patients can be achieved. We designed a hybrid force/position control scheme for the sampling robot to achieve intuitive operation and stable contact force. The experiment results on phantom tissue show that the sampling robot can achieve intuitive operation and stable contact on the soft posterior pharyngeal. Clinical trials for 20 volunteers and 2 patients diagnosed with COVID-19 are carried out. The results of the clinical trial indicated that the sampling robot can collect samples stably and effectively, and the contact force is gentler and more uniform. For two patients diagnosed with COVID-19, the robot sampling results are consistent with manual sampling. IEEE

17.
World Journal of Dentistry ; 13(5):434-440, 2022.
Article in English | Scopus | ID: covidwho-1975165

ABSTRACT

Aim: Evaluation of oral lesions in COVID-hospitalized patients, analyzing the potential etiopathogenetic mechanisms. Materials and methods: We evaluated a total of 58 hospitalized COVID patients in the time span from April 2021 to May 2021. The group analyzed consists of 38 male patients (66%) and 20 female patients (34%), aged between 22 and 92, with a preponderance of 60–80 years. All patients underwent an oral evaluation in order to detect the various oral manifestations;moreover, the onset time of these lesions has been correlated with the time of manifestation of the general symptoms of COVID infection. Results: Xerostomia has been the most frequent oral manifestation detected (30 patients, 51.7% of the sample), followed by ageusia (16 patients, 27.6%), and white tongue (13 patients, 22.4%). Other oral manifestations observed were aphthous lesions, fissured tongue, metallic taste, tingling in the lip and chin, and burning mouth syndrome. Conclusion: Our findings show a significant correlation between the oral manifestations and the burst of viral replication phase in COVID patients. Clinical significance: Awareness of the possible oral manifestations of COVID infection is important to conduct a correct diagnosis in oral pathology. © The Author(s). 2022.

18.
NeuroQuantology ; 20(8):1519-1527, 2022.
Article in English | EMBASE | ID: covidwho-1969848

ABSTRACT

This study investigated dental problems and radiological and cardiac evaluations in patients affected by Covid-19. Heart disease is related to the health of the teeth, and people who have damaged and decayed teeth are more prone to cardiovascular disease. Researchers have concluded that poor dental hygiene is a sign of acute heart disease risks. In the report presented by Tarje Imna service, a group of researchers examined almost 65 thousand people infected with the corona virus in order to evaluate the effects of the covid 19 virus on the oral and dental health of the affected people. According to the results of this research, one of the effects of the corona virus on the body is the reduction of oral moisture. Almost 43% of patients accepted this effect. In general, dry mouth is one of the causes of oral and dental diseases, especially bad breath. Corona virus also increases the risk of tooth decay by reducing the moisture in the mouth. Another effect of the corona virus on the mouth and teeth is to cause ulcers in the gums and tongue. Of course, in this case, researchers do not comment with certainty, because they believe that other factors are also effective in causing these wounds. Some experts say that considering that more than 47 percent of adults who are 30 years old or older have periodontal diseases, such as gum infection, inflammation of the gums and bone around the teeth. We should expect that the existing dental and oral problems will become more acute in case of infection with Covid-19.

19.
Laryngo- Rhino- Otologie ; 101:S335, 2022.
Article in English | EMBASE | ID: covidwho-1967688

ABSTRACT

Purpose We investigated the prevalence of smell and/or taste loss and the clinical characteristics and recovery in a cohort of consecutive patients treated by two COVID-19 reference hospitals and evaluated the late persistence of hyposmia. Material and Methods 53 consecutive RT-PCR diagnosed patients (23 males, 30 females, 42,54 ± 10, 95 years) who had been hospitalized between January- June 2021 in the COVID-19 care wards were contacted, excluding patients with cognitive disorders and severe deconditioning. These patients (Group A) have been examined twice, once direct after leaving the hospital, and once again 4-6 weeks later. The patients- nasal and oral mucosa (Fungiform Papillae on tongue-s tip-fPap) were examined with a contact endoscope. Their olfaction was also examined with Sniffin' Sticks. As control-group we have examined 53 healthy subjects (Group B). Results Significant alterations in form and vascularization of fPap have been detect, specially by the first examination. Patients EGM-Thresholds of both measurements are higher than those of healthy subjects, although those of the second one are clearly lower. The same results have been found using Schniffin- Sticks. Discussion Our findings suggest that COVID-19 can produce a mild to profound neuropathy of multiple cranial nerves, which are responsible for the regeneration of fPap and the transmission of the chemical stimuli.

20.
Community Practitioner ; 95(4):40-43, 2022.
Article in English | ProQuest Central | ID: covidwho-1958033

ABSTRACT

In the second of a two-part series, Holland shares the outstanding work done during the pandemic. Among others, Rachel Raymond supported the development of local health visiting hubs and ways to deliver the Welsh Government's Healthy Child Wales Programme from 2016. She also supported staff through the Covid-19 pandemic as they adapted to different ways of working and assisted at vaccination centres.

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