Smell loss associated with SARS-CoV-2 is not clinically different from other viruses: a multicenter cohort study.

BACKGROUND: Although the COVID-19 pandemic has increased the prevalence of cases with olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on olfactory symptoms. METHODS: Patients with sudden smell loss were recruited in a multicenter prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to perform a PCR-based respiratory viral panel were collected at first visit (day 0) and 30 and 60 days after recruitment. RESULTS: 188 of 213 patients presented positive test result for SARS-CoV-2, among which 65 were co-infected with other respiratory viruses (e.g., rhinovirus, enterovirus, and parainfluenza). 25 had negative test results for SARS-CoV-2. Patients in both SARSCoV-2 and non-SARS-CoV-2 groups had objective anosmia (less than 2 points according to the psychophysical olfactory CCCRC) at day 0, with no significant difference between them. Both groups had significant smell scores improvement after 30 and 60 days, with no difference between them. Co-infection with other respiratory viruses, and SARS-CoV-2 viral load did not impact olfactory scores. CONCLUSION: Patients with sudden smell loss associated with SARS-CoV-2 and other respiratory viruses had similar presentation, with most participants initiating with anosmia, and total or near total recovery after 60 days. SARS-CoV-2 viral load and co-infections with other respiratory viruses were not associated with poorer olfactory outcomes.

Importance of a critical reading of neuropsychological testing.

Neuropsychological testing has become an important part of the diagnostic tools available to assess children's functioning. Tests are routinely use to establish diagnosis, measure patient's impairment and drive rehabilitation. The authors present the clinical case of a eight-year-old girl, sent to our Child Neuropsychiatry and Rehabilitation Unit for a suspected Specific Learning Disorder. Peculiar findings regarding attention and reading ability became evident during the initial evaluation; a mistaken diagnosis of dyslexia was avoided by carefully examining her global functioning (in particular sight, as she suffered from hyperopia but more importantly she had an insufficient control of vertical saccadic movements) and the strategies she used during testing. This constitutes a good example of the need to take into consideration the patient as a whole during any assessment, including neuropsychological testing.

Child rehabilitation refusal: why it happens and possible strategies to avoid it.

AIM: Despite an obvious need for rehabilitative treatment, some parents deny consent and some others withdraw their children from a previously accepted program. There is limited literature concerning how to prevent this, serving the child's best interest, and the existing is mainly focused on legal implications. METHODS: This was a naturalistic study, carried out using data obtained during the diagnostic evaluation of 166 children (all those seen in the Child Neuropsychiatry Unit). For 25 children (15.1%), parents refused or interrupted suggested treatment. RESULTS: Statistical analysis showed that there is a significant difference in terms of impairment in children of parents accepting or refusing the rehabilitative treatment. Treatment discontinuation is related to the diagnosis (higher percentage in severe language disorders or complex developmental disorders), higher reduction in global functioning, higher disability burden, need for integrated treatment, lower age. CONCLUSIONS: Findings of this study could be useful in order to better plan rehabilitative options and goals. It is possible that an attempt to increase parental involvement in the rehabilitative program could lead to a decrease in treatment discontinuation. Anyway, more research is needed because we are still far from having a good predictive model to anticipate and, if possible, avoid treatment discontinuation.