Assessment of COVID-19-related olfactory dysfunction and its association with psychological, neuropsychiatric, and cognitive symptoms.

Purpose of review: To provide a detailed overview of the assessment of COVID-19-related olfactory dysfunction and its association with psychological, neuropsychiatric, and cognitive symptoms. Recent findings: COVID-19-related olfactory dysfunction can have a detrimental impact to the quality of life of patients. Prior to the COVID-19 pandemic, olfactory and taste disorders were a common but under-rated, under-researched and under-treated sensory loss. The pandemic has exacerbated the current unmet need for accessing good healthcare for patients living with olfactory disorders and other symptoms secondary to COVID-19. This review thus explores the associations that COVID-19 has with psychological, neuropsychiatric, and cognitive symptoms, and provide a framework and rationale for the assessment of patients presenting with COVID-19 olfactory dysfunction. Summary: Acute COVID-19 infection and long COVID is not solely a disease of the respiratory and vascular systems. These two conditions have strong associations with psychological, neuropsychiatric, and cognitive symptoms. A systematic approach with history taking and examination particularly with nasal endoscopy can determine the impact that this has on the patient. Specific olfactory disorder questionnaires can demonstrate the impact on quality of life, while psychophysical testing can objectively assess and monitor olfaction over time. The role of cross-sectional imaging is not yet described for COVID-19-related olfactory dysfunction. Management options are limited to conservative adjunctive measures, with some medical therapies described.

Efficacy and safety of vesatolimod in chronic hepatitis B: A systematic review and meta-analysis.

BACKGROUND: Vesatolimod is a toll-like receptor (TLR) agonist that is thought to suppress chronic hepatitis B (HBV) infection. This systematic review aimed to assess the safety and efficacy of vesatolimod in treating chronic hepatitis B. METHODS: We included randomized clinical trials (RCTs) that assessed vesatolimod in patients with hepatitis B infection without hepatocellular carcinoma or liver transplantation and with reported levels of hepatitis B surface antigen (HBsAg) or liver transaminases post-intervention. We searched MEDLINE, SCOPUS, Springer, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Clinical Trials for all related articles during May 2022. Two independent authors screened articles for inclusion, and discrepancies were resolved by consensus and a third reviewer. Two independent reviewers assessed studies included in this systematic review using the Critical Appraisal Skills Programme checklist for RCTs. RESULTS AND CONCLUSION: Only 4 were considered eligible from 391 articles identified through our search. All eligible studies did not report any clinically significant outcomes following the use of vesatolimod, as evidenced by the persistence of HBsAg. However, vesatolimod was associated with induction of interferon-stimulated genes (ISGs) and only mild side effects, warranting further studies to evaluate its potential for future use as a safe, tolerable anti-HBV medication. No significant differences were noted amongst trials included in either of Vesatolimod doses (Vesatolimod 1 mg, RR = 0.99, 95% CI 0.76-1.30, P = .95, I2 = 0%; Vesatolimod 2 mg, RR = 1.06, 95% CI 0.82-1.37, P = .66, I2 = 0%; Vesatolimod 4 mg, RR = 1.06, 95% CI 0.82-1.37, P = .66, I2 = 0%;), further suggesting its comparable safety in comparison to oral antiviral agents.

A Case of Recurrent Isolated Uvula Oedema Secondary to Obesity and Obstructive Sleep Apnoea.

A 34-year-old male presented as an emergency with sudden onset globus, stertor and choking whilst asleep. He had similar previous episodes that self-resolved. The patient's observations were all within normal range. On examination, he had a grossly enlarged, non-erythematous uvula and there were no signs of respiratory distress or stridor. He was managed with intravenous dexamethasone and an attempt at needle aspiration of the uvula was made but there was no clinical improvement in the patient's condition. Despite no improvement with therapy, he was monitored overnight for any signs of airway compromise and discharged the following morning. His symptoms completely resolved on follow-up in the otolaryngology clinic a week later. He was diagnosed with Quincke's oedema caused by his obesity and background of obstructive sleep apnoea. We discuss the various aetiologies, assessment, and management of Quincke's oedema.

Transnasal endoscopic repair of choanal atresia in a tertiary care centre: a review of outcomes.

INTRODUCTION/AIM: Choanal atresia (CA) is an obliteration, in newborns, of the airway at the level of posterior nasal aperture resulting in absence of connection between the nasal cavity and the aerodigestive tract. It is rare, with incidence of 1 in 7000 live births. This review is aimed at assessing the factors influencing the outcome of transnasal endoscopic repair of CA in a tertiary referral children's hospital. MATERIAL/METHOD: A retrospective study was carried out between 2002 and 2009. 31 children; 14 boys and 17 girls, age range 1 day to 15 years, mean 23.4 months were included. Unilateral presentation was 19 (11 right, 8 left) and bilateral was 12. All patients had transnasal endoscopic repair under direct vision. Nasal stents were placed for varying duration (range 4-12 weeks) or nasopharyngeal airways (removed within 24h) were inserted at time of surgery. Patients were monitored for re-stenosis and revisions carried out as necessary, with a mean follow-up of 11.9 months. RESULTS: 54.7% (n=17) of patients had re-stenosis requiring revision surgery. Of these, 41.1% (n=7) had success after the 1st revision, 20% had success after the 2nd revision while 12.3% had success after the 3rd revision. One patient required more than four revisions. 80% of re-stenosis requiring revisions occurred in children who had surgery under 10 months of age and of these, approx. 42% were 1-week-old or younger. 57% of those who had stents for 4-6 weeks (n=15) had re-stenosis requiring revision while only 33.3% of those who either had no stents or had NP airways removed within 24h (n=16) had re-stenosis (P=0.019). The re-stenosis rate was comparable for those who had mitomycin (53%) versus those who did not (60%). CONCLUSION: Transnasal endoscopic repair of CA is effective and safe and provides the benefit of surgery under direct vision. Age 1 week or less was a predictive factor for re-stenosis. Intranasal stents was also associated with increased incidence of re-stenosis and the use of mitomycin C does not seem to have any significant effect on re-stenosis.