Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in sleep in which the airways narrow or collapse during sleep, causing obstructive sleep apnea. The prevalence of OSAS continues to rise worldwide, particularly in middle-aged and elderly individuals. The mechanism of upper airway collapse is incompletely understood but is associated with several factors, including obesity, craniofacial changes, altered muscle function in the upper airway, pharyngeal neuropathy, and fluid shifts to the neck. The main characteristics of OSAS are recurrent pauses in respiration, which lead to intermittent hypoxia (IH) and hypercapnia, accompanied by blood oxygen desaturation and arousal during sleep, which sharply increases the risk of several diseases. This paper first briefly describes the epidemiology, incidence, and pathophysiological mechanisms of OSAS. Next, the alterations in relevant signaling pathways induced by IH are systematically reviewed and discussed. For example, IH can induce gut microbiota (GM) dysbiosis, impair the intestinal barrier, and alter intestinal metabolites. These mechanisms ultimately lead to secondary oxidative stress, systemic inflammation, and sympathetic activation. We then summarize the effects of IH on disease pathogenesis, including cardiocerebrovascular disorders, neurological disorders, metabolic diseases, cancer, reproductive disorders, and COVID-19. Finally, different therapeutic strategies for OSAS caused by different causes are proposed. Multidisciplinary approaches and shared decision-making are necessary for the successful treatment of OSAS in the future, but more randomized controlled trials are needed for further evaluation to define what treatments are best for specific OSAS patients.

A novel anterior nasal swab to detect respiratory viruses: a prospective study of diagnostic accuracy.

Detection of respiratory viruses requires testing of the upper respiratory tract to obtain specimens for analysis. However, nasal and throat swabs can cause discomfort and procedural anxiety in children. Respiratory sampling methods which are accurate and less invasive are needed. We aim to determine the positive and negative percentage agreement of a novel anterior nasal swab (ANS) compared with the combined throat and anterior nasal swab (CTN), the reference standard, for detection of respiratory viruses. Children 5 - 18 years of age presenting to a tertiary paediatric hospital with respiratory symptoms were tested with both swabs in randomised order. Respiratory samples were tested on a multiplex RT-PCR panel. Viral detections, RT-PCR cycle-threshold values and child/parent/clinician experience of the swab were recorded. There were 157 viral detections from 249 participant CTN swabs. In comparison with the CTN, the overall positive and negative percentage agreement of ANS for detection of respiratory viruses was 96.2% (95% CI, 91.8-98.3%) and 99.8% (95% CI, 99.6-99.9%), respectively. The ANS was "extremely comfortable", or only a "little uncomfortable" for 90% of children compared with 48% for CTN. 202 children (84%) rated the ANS as the preferred swab, and 208 (87%) indicated they would prefer ANS for future testing. The ANS required additional laboratory handling processes compared to the CTN. The ANS has high positive percentage agreement and is comparable to the current standard of care. The high acceptability from the less invasive ANS provides a more comfortable method for respiratory virus testing in children.Trial registrationClinicalTrials.gov ID NCT05043623.

[A cross-sectional study of enterovirus nucleic acid test with throat swabs for term late neonates during coronavirus disease 2019]. / æ–°åž‹å† çŠ¶ç— æ¯’æ„ŸæŸ“æœŸé—´è¶³æœˆçš„æ™šæœŸæ–°ç”Ÿå„¿å’½æ‹­å­è‚ é“ç— æ¯’æ ¸é ¸æ£€æµ‹æ¨ªæ–­é¢ç ”ç©¶.

OBJECTIVES: To investigate the positive rate of enterovirus (EV) nucleic acid in throat swabs of term late neonates hospitalized during the coronavirus disease 2019 (COVID-19) epidemic and the clinical characteristics of the neonates. METHODS: A single-center cross-sectional study was performed on 611 term late infants who were hospitalized in the neonatal center from October 2020 to September 2021. Throat swabs were collected on admission for coxsackie A16 virus/EV71/EV universal nucleic acid testing. According to the results of EV nucleic acid test, the infants were divided into a positive EV nucleic acid group (8 infants) and a negative EV nucleic acid group (603 infants). Clinical features were compared between the two groups. RESULTS: Among the 611 neonates, 8 tested positive for EV nucleic acid, with a positive rate of 13.1‰, among whom 7 were admitted from May to October. There was a significant difference in the proportion of infants contacting family members with respiratory infection symptoms before disease onset between the positive and negative EV nucleic acid groups (75.0% vs 10.9%, P<0.001). There were no significant differences between the two groups in demographic data, clinical symptoms, and laboratory test results (P>0.05). CONCLUSIONS: There is a certain proportion of term late infants testing positive for EV nucleic acid in throat swabs during the COVID-19 epidemic, but the proportion is low. The clinical manifestations and laboratory test results of these infants are non-specific. Transmission among family members might be an important cause of neonatal EV infection.

Exploring Diagnostic Strategies for Streptococcal Throat Infection Remotely: A Feasibility Study.

Context: Acute sore throat is a common presentation in primary care and often results in antibiotic prescription. The Covid pandemic has driven changes in consultation with less face to face visits. Scoring tools are available to target antibiotics and widely used in the UK but it is not clear whether patient self assessment is feasible and sufficiently precise to enable remote use of scoring tools. Objective: A feasibility study to develop and test remote assessment of acute sore throat. Design: Observational study Setting: UK primary care Population: Adults and children with sore throat were asked to use the online tool and report their clinical findings directly Intervention: An online tool was developed that could help patients or parents of children with sore throat assess the clinical features that make up clinical prediction rules and to take a photograph of the throat Results: 221 patients with sore throat were screened and 45 (33 adults and 12 children) were recruited. 44/45 (97.8%) participants were able to complete all elements of the clinical assessment. It was possible to calculate a FeverPAIN score for 25 (75.8%) adults and 10 (83.3%) children. 35 participants (25 (75.8%) adults and 10 (83.3%) children) provided a throat photograph but many of these were not of sufficient quality to enable assessment of throat pus and inflammation. Poor lighting and focus were the main problems. Photos that were of sufficient quality were available from 13 (39.4%) adults and 5 (41.7%) children. Three GPs independently assessed these photographs to assess for inflammation and pus. Using the clinician assessment as the reference standard, self/parent/carer assessment of inflammation had a sensitivity of 100%, specificity of 46.7%, positive predictive value (PPV) of 27.3% and negative predictive value (NPV) of 100%. The sensitivity, specificity, PPV and NPV for pus were 76.5%, 100%, 71.4%, 42.9% and 100%. Conclusions: Self assessment of sore throat was possible. Photographs were of sufficient quality for clinical assessment less than half the time. Patients/parents/carers are very good at ruling out pus and inflammation, but have a tendency to overcall these findings, especially inflammation. Further implications for self assessment and future work will be described.

Upper airway dimensions and the skeletal parameters in orthodontic patients who developed moderate-severe COVID-19 symptoms during the pandemic.

BACKGROUND: Large airway dimensions are associated with a rapid decline in the lung function and a higher risk of hospitalization. Therefore, the airway dimensions of healthy subjects who tested positive for coronavirus disease 2019 (COVID-19) may be associated with the severity of COVID-19 symptoms. OBJECTIVES: The objectives of this study were to measure the upper airway dimensions and the craniofacial skeletal parameters in patients who tested positive for COVID-19, to compare the upper airway dimensions and the craniofacial skeletal parameters between patients who developed no/mild symptoms and those with moderate-severe COVID-19 symptoms, and to assess any association of the skeletal relationships (anteroposterior (AP) and vertical) and the upper airway dimensions with the severity of COVID-19 symptoms in adult subjects. MATERIAL AND METHODS: A total of 204 orthodontic patients who tested positive for COVID-19 were evaluated. Of these, only 137 met the inclusion criteria. The sample was further subdivided into 2 groups based on the severity of symptoms: cases (moderate-severe symptoms; n = 56); and controls (asymptomatic/ mild symptoms; n = 81). The upper airway dimensions and the skeletal parameters were measured on lateral cephalograms. The nonparametric Mann-Whitney U test was used to detect differences between the cases and the controls. Binary logistic regression analysis was used to evaluate the association between the studied variables and the severity of symptoms. RESULTS: The cases had a reduced lower face height (LFH) and a reduced perpendicular distance from the hyoid bone to the line connecting the anteroinferior limit of the 3rd cervical vertebra (C3) and the retrognathion point (RGN) (HH1) as compared to the controls. Regression analysis revealed a significant association of LFH (p = 0.013), the vertical airway length (VAL) (p = 0.002) and HH1 (p = 0.021) with the severity of COVID-19 symptoms. CONCLUSIONS: The types of malocclusion were similar in the cases and the controls. Patients with reduced LFH and VAL, and a superiorly positioned hyoid bone in relation to the mandible developed more severe COVID-19 symptoms.

"COVID gave him an opportunity to tighten the reins around my throat": perceptions of COVID-19 movement restrictions among survivors of intimate partner violence.

BACKGROUND: Intimate Partner Violence (IPV) poses a serious public health threat globally and within the United States. Preliminary evidence highlighted surges in IPV during the COVID-19 pandemic. The pandemic offers a unique context, with many states and countries enacting movement-restrictions (i.e., shelter-in-place orders) that exacerbated IPV. Although these movement restrictions and other infection control methods (i.e., isolation, quarantine orders) have proven successful in reducing the spread of COVID-19, their impacts on IPV have not been thoroughly investigated. Specifically, public health measures restricting movement reinforce and socially legitimize isolation and coercive control tactics enacted by perpetrators of abuse. The purpose of this study was to understand the impacts of COVID-19, including the impacts of movement restrictions (i.e., shelter in place orders, quarantine, isolation orders) on experiences of IPV from the perspective of survivors. METHODS: In-depth interviews were conducted with ten survivors who presented at a large, public hospital or sought community IPV resources (i.e., domestic violence shelter, therapy services) in Atlanta, Georgia between March and December 2020. Thematic analysis was carried out to describe the impact of COVID-19 movement restrictions on IPV and help-seeking behaviors among survivors, in addition to identifying resources to improve IPV response during pandemics. RESULTS: Through discussion of their experiences, survivors indicated how movement restrictions, social distancing measures, and the repercussions of the pandemic influenced their relationship challenges, including the occurrence of new or a higher frequency and/or severity of IPV episodes. Survivors cited relationship challenges that were amplified by either movement restrictions or consequences of COVID-19, including reinforced control tactics, and increased financial or life stressors resulting from the pandemic. COVID-19 movement restrictions catalyzed new relationships quickly and sparked new or intensified violence in existing relationships, revealing gaps in IPV support services. CONCLUSION: These findings suggest COVID-19 movement restrictions and social distancing measures amplify IPV and experiences of trauma due to new or exacerbated relationship challenges. Further, results highlight how partners cited COVID-19 movement restrictions to justify methods of coercive control. Public health professionals engaged in pandemic preparedness must give serious consideration to how social distancing measures may amplify trauma in those experiencing IPV.

Swab the Throat as Well as the Nose? The Debate Over the Best Way to Test for SARS-CoV-2.

This Medical News article discusses whether swabbing both the nose and the throat might improve the sensitivity of rapid antigen COVID-19 tests.

In asymptomatic adults, a COVID-19 Ag-RDT with combined nasal and throat samples had 82% to 89% positive percent agreement.

SOURCE CITATION: Goodall BL, LeBlanc JJ, Hatchette TF, et al. Investigating the sensitivity of nasal or throat swabs: combination of both swabs increases the sensitivity of SARS-CoV-2 rapid antigen tests. Microbiol Spectr. 2022;10:e0021722 35762772.

Stable thyroid function despite regular use of povidone-iodine throat spray for SARS-CoV-2 prophylaxis.

BACKGROUND: It is unclear whether unintentional ingestion of povidone-iodine following its application to the oropharyngeal space could affect thyroid function. OBJECTIVE: To examine thyroid function among individuals who regularly apply povidone-iodine throat spray for SARS-CoV-2 prophylaxis. METHODS: We designed a case-control study to compare thyroid function among participants who received povidone-iodine throat spray three times a day for 42 days ('cases') and those who received vitamin C ('controls'). Thyroid function was assessed by profiling serum TSH, free T3, and free T4; iodine status was estimated using serum thyroglobulin level, while infection status was determined by measuring anti-SARS-CoV-2 antibody against the nucleocapsid antigen. All measurements were performed in pairs, at baseline and 42 days later. Pre-post changes in thyroid function were compared between groups, before and after stratification according to baseline TSH quartiles. RESULTS: A total of 177 men (117 cases and 60 controls) (mean age, 32.2 years) were included. Despite comparable demographics and clinical profiles, no clinically or statistically significant differences were observed in thyroid indices between 'cases' and 'controls' before and after stratification according to TSH quartiles. None of the participants developed symptomatic hypo- or hyperthyroidism throughout the study. Post-hoc analysis did not reveal differences in thyroid function according to infection status. CONCLUSIONS: Data from this study support the overall safety of povidone-iodine use in the oropharyngeal space for SARS-CoV-2 prophylaxis among individuals with normal thyroid function and subclinical thyroid disease.

Randomized, Double-Blind, Placebo-Controlled Trial of a Throat Spray with Selected Lactobacilli in COVID-19 Outpatients.

Primary care urgently needs treatments for coronavirus disease 2019 (COVID-19) patients because current options are limited, while these patients who do not require hospitalization encompass more than 90% of the people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we evaluated a throat spray containing three Lactobacillaceae strains with broad antiviral properties in a randomized, double-blind, placebo-controlled trial. Before the availability of vaccines, 78 eligible COVID-19 patients were randomized to verum (n = 41) and placebo (n = 37) within 96 h of a positive PCR-based SARS-CoV-2 diagnosis, and a per-protocol analysis was performed. Symptoms and severity were reported daily via an online diary. Combined nose-throat swabs and dried blood spots were collected at regular time points in the study for microbiome, viral load, and antibody analyses. The daily reported symptoms were highly variable, with no added benefit for symptom resolution in the verum group. However, based on 16S V4 amplicon sequencing, the acute symptom score (fever, diarrhea, chills, and muscle pain) was significantly negatively associated with the relative abundance of amplicon sequence variants (ASVs) that included the applied lactobacilli (P < 0.05). Furthermore, specific monitoring of these applied lactobacilli strains showed that they were detectable via quantitative PCR (qPCR) analysis in 82% of the patients in the verum group. At the end of the trial, a trend toward lower test positivity for SARS-CoV-2 was observed for the verum group (2/30; 6.7% positive) than for the placebo group (7/27; 26% positive) (P = 0.07). These data indicate that the throat spray with selected antiviral lactobacilli could have the potential to reduce nasopharyngeal viral loads and acute symptoms but should be applied earlier in the viral infection process and substantiated in larger trials. IMPORTANCE Viral respiratory tract infections result in significant health and economic burdens, as highlighted by the COVID-19 pandemic. Primary care patients represent 90% of those infected with SARS-CoV-2, yet their treatment options are limited to analgesics and antiphlogistics, and few broadly acting antiviral strategies are available. Microbiome or probiotic therapy is a promising emerging treatment option because it is based on the multifactorial action of beneficial bacteria against respiratory viral disease. In this study, an innovative topical throat spray with select beneficial lactobacilli was administered to primary COVID-19 patients. A remote study setup (reducing the burden on hospitals and general practitioners) was successfully implemented using online questionnaires and longitudinal self-sampling. Our results point toward the potential mechanisms of action associated with spray administration at the levels of viral loads and microbiome modulation in the upper respiratory tract and pave the way for future clinical applications of beneficial bacteria against viral diseases.

The Clinical Significance of Otolaryngology Manifestations in COVID-19 Pneumonia: A Single-center Retrospective Cohort Study.

Objective Although the absence of a runny nose and sore throat, both ear-nose-throat (ENT) symptoms, suggests community-acquired pneumonia (CAP), the association between ENT symptoms and coronavirus disease 2019 (COVID-19) pneumonia remains unclear. We therefore investigated the association between ENT symptoms and COVID-19 pneumonia. Methods We retrospectively recruited consecutive confirmed COVID-19 inpatients with and without pneumonia admitted to a single institution from April 1, 2020, to July 31, 2021. After a descriptive analysis, we implemented univariable and multivariable regression analyses to assess the association between ENT symptoms and COVID-19 pneumonia. Results The present study included 385 patients. Pneumonia patients exhibited lower rates of positive runny nose and sore throat than non-pneumonia patients. Univariable analyses found mean odds ratios of 0.59 and 0.61 and 95% confidence intervals (CIs) of 0.30-1.16 and 0.32-1.17 for runny nose and sore throat, respectively, and multivariable analyses found mean odds ratios of 0.73 and 0.70 and 95% CIs of 0.34-1.56 and 0.34-1.46, respectively. Conclusion Our study found no statistically significant association between ENT symptoms and COVID-19 pneumonia. Clinicians should be aware that, unlike CAP, there is no correlation between ENT symptoms and pneumonia among patients with COVID-19, so it is necessary to consider the possibility of pneumonia even in the presence of ENT symptoms.

Evolution of throat symptoms during the COVID-19 pandemic in the US.

OBJECTIVES: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) structure and host tropism have changed over time, and so has the involvement of throat structures. This infodemiological analysis is hence aimed at investigating the evolution of throat symptoms during the COVID-19 pandemic in the US. METHODS: We searched Google Trends using the medical search terms "ageusia", "hoarseness", "dysphonia", "pharyngitis" and "laryngitis", setting geographical location to "United States", within the past 5 years. The weekly Google Trends score for these symptoms, which reflects their national Web popularity, was divided in three parts, as "pre-COVID" (July 2017 to February 2020), COVID-19 "pre-Omicron" (March 2020 to November 2021), and COVID-19 "Omicron" (December 2021 to July 2022), and then compared. RESULTS: The volume of searches for ageusia increased in the pre-Omicron period and remained significantly higher also during Omicron prevalence, though a significant decrease (∼30%) occurred with Omicron lineages compared to previous strains. The Google searches for hoarseness and dysphonia were relatively similar between the pre-COVID and pre-Omicron periods, but then significantly increased during Omicron predominance. The Google searches for pharyngitis and laryngitis decreased in the pre-Omicron period, but then considerably increased following Omicron emergence. Omicron endemic spread could be significantly and independently predicted by the volume of searches for pharyngitis, laryngitis and hoarseness. CONCLUSIONS: The epidemiological burden of throat symptoms has considerably changed after Omicron emergence, with a lower likelihood of developing chemosensory dysfunctions and enhanced risk of throat involvement.

SARS-CoV-2 RNA in exhaled air of hospitalized COVID-19 patients.

Knowledge about contagiousness is key to accurate management of hospitalized COVID-19 patients. Epidemiological studies suggest that in addition to transmission through droplets, aerogenic SARS-CoV-2 transmission contributes to the spread of infection. However, the presence of virus in exhaled air has not yet been sufficiently demonstrated. In pandemic situations low tech disposable and user-friendly bedside devices are required, while commercially available samplers are unsuitable for application in patients with respiratory distress. We included 49 hospitalized COVID-19 patients and used a disposable modular breath sampler to measure SARS-CoV-2 RNA load in exhaled air samples and compared these to SARS-CoV-2 RNA load of combined nasopharyngeal throat swabs and saliva. Exhaled air sampling using the modular breath sampler has proven feasible in a clinical COVID-19 setting and demonstrated viral detection in 25% of the patients.

Pathogen detection and characterization from throat swabs using unbiased metatranscriptomic analyses.

OBJECTIVES: Infectious diseases are common but are not easily or readily diagnosed with current methodologies. This problem is further exacerbated by the constant presence of mutated, emerging, and novel pathogens. One of the most common sites of infection by many pathogens is the human throat. However, there is no universal diagnostic test that can distinguish these pathogens. Metatranscriptomic (MT) analysis of the throat represents an important and novel development in infectious disease detection and characterization, because it is able to identify all pathogens using a fully unbiased approach. METHODS: To test the utility of an MT approach to pathogen detection, throat samples were collected from participants before, during, and after an acute sickness. RESULTS: Clear sickness-associated shifts in pathogenic microorganisms were detected in the patients. Important insights into microbial functions and antimicrobial resistance genes were obtained. CONCLUSION: MT analysis of the throat represents an effective method for the unbiased identification and characterization of pathogens. Because MT data include all microorganisms in the sample, this approach should not only allow the identification of pathogens, but provide an understanding of the effects of the resident throat microbiome in the context of human health and disease.

Investigating the Sensitivity of Nasal or Throat Swabs: Combination of Both Swabs Increases the Sensitivity of SARS-CoV-2 Rapid Antigen Tests.

The COVID-19 pandemic has been hallmarked by several waves of variants of concern (VoCs), each with novel challenges. Currently, the highly transmissible Omicron VoC is predominant worldwide, and sore throat is common, among other cold-like symptoms. Anecdotes on social media have suggested that sampling one's throat can increase the sensitivity for Omicron detection by antigen-based rapid testing devices (Ag-RDTs). This work aimed to improve the local testing strategy and determine whether the sensitivity of Ag-RDTs designed for nasal sampling is altered with the use of self-administered throat swabs in self-perceived asymptomatic individuals. This investigation used a common Ag-RDT (i.e., Abbott Panbio COVID-19 Ag rapid test device) to compare three sampling sites: nasal swab, throat swab, and combined nasal/throat. All Ag-RDT results were confirmed with molecular testing from residual test buffer. Compared to reverse transcriptase PCR (RT-PCR), samples from nasal or throat swabs each detected 64.5% of SARS-CoV-2 cases; however, combining the contributions of each swab increased the positive percent agreement (PPA) with RT-PCR to 88.7%. This trend was also evident with the Rapid Response Ag-RDT (BTNX), which uses more flexible swabs than does the Panbio. When nasal swab collection was compared to paired sampling of the nose/throat using a single swab with the Panbio Ag-RDT, the PPAs were 68.4% and 81.6%, respectively. No false-positive results were observed with nasal, throat, or combined nasal/throat sampling. Self-administered throat and nasal/throat swabs both had >90% acceptability. These findings support the use of self-collected combined nasal/throat sampling for Ag-RDT-based SARS-CoV-2 detection in self-perceived asymptomatic individuals. IMPORTANCE This quality project demonstrates that combining the results of nasal and throat swabs or using a combined single swab of the throat and nares resulted in increased detection of SARS-CoV-2 using a rapid antigen test, in an asymptomatic population. Importantly, no false positives were detected, and over 90% of people were willing to perform the combination swab. These types of projects are instrumental in informing local practices to improve testing strategies. These data support the option of using a combined nasal/throat swab in our local setting to enhance the detection of Omicron.