A review of smell and taste dysfunction in COVID-19 patients.

INTRODUCTION: Multiple anecdotal reports suggest that smell and taste loss were early subclinical symptoms of COVID-19 patients. The objective of this review was to identify the incidence of smell and taste dysfunction in COVID-19, determine the onset of their symptoms and the risk factors of anosmia, hyposmia, ageusia or dysgeusia for COVID-19 infection. METHODS: We searched the PubMed and Google Scholar on 15th May 2020, with search terms including SARS-COV-2, coronavirus, COVID-19, hyposmia, anosmia, ageusia and dysgeusia. The articles included were cross sectional studies, observational studies and retrospective or prospective audits, letters to editor and short communications that included a study of a cohort of patients. Case reports, case-series and interventional studies were excluded. DISCUSSION: A total of 16 studies were selected. Incidence of smell and taste dysfunction was higher in Europe (34 to 86%), North America (19 to 71%) and the Middle East (36 to 98%) when compared to the Asian cohorts (11 to 15%) in COVID-19 positive patients. Incidence of smell and taste dysfunction in COVID-19 negative patients was low in comparison (12 to 27%). Total incidence of smell and taste dysfunction from COVID-19 positive and negative patients from seven studies was 20% and 10% respectively. Symptoms may appear just before, concomitantly, or immediately after the onset of the usual symptoms. Occurs predominantly in females. When occurring immediately after the onset of the usual symptoms, the median time of onset was 3.3 to 4.4 days. Symptoms persist for a period of seven to 14 days. Patients with smell and taste dysfunction were reported to have a six to ten-fold odds of having COVID-19. CONCLUSION: Smell and taste dysfunction has a high incidence in Europe, North America, and the Middle East. The incidence was lower in the Asia region. It is a strong risk factor for COVID-19. It may be the only symptom and should be added to the list of symptoms when screening for COVID- 19.

Upper respiratory tract sampling in COVID-19.

INTRODUCTION: To review the present literature on upper respiratory tract sampling in COVID-19 and provide recommendations to improve healthcare practices and directions in future studies. METHODS: Twelve relevant manuscripts were sourced from a total of 7288 search results obtained using PubMed, Medline and Google Scholar. The search keywords used were COVID-19, nasopharyngeal, oropharyngeal, swabs, SARS and CoV2. Original manuscripts were obtained and analysed by all authors. The review included manuscripts which have not undergone rigorous peer-review process in view of the magnitude of the topic discussed. RESULTS: The viral load of SARS-CoV-2 RNA in the upper respiratory tract was significantly higher during the first week and peaked at 4-6 days after onset of symptoms, during which it can be potentially sampled. Nasopharyngeal swab has demonstrated higher viral load than oropharyngeal swab, where the difference in paired samples is best seen at 0-9 days after the onset of illness. Sensitivity of nasopharyngeal swab was higher than oropharyngeal swabs in COVID-19 patients. Patient self-collected throat washing has been shown to contain higher viral load than nasopharyngeal or oropharyngeal swab, with significantly higher sensitivity when compared with paired nasopharyngeal swab. RECOMMENDATIONS: Routine nasopharyngeal swab of suspected COVID-19 infection should take anatomy of the nasal cavity into consideration to increase patient comfort and diagnostic yield. Routine oropharyngeal swab should be replaced by throat washing which has demonstrated better diagnostic accuracy, and it is safe towards others.

Aetiological profile of paediatric stridor in a Malaysian tertiary hospital.

BACKGROUND: Conditions causing stridor in paediatric patients can range from minor illnesses to life-threatening disorders. Proper evaluation and correct diagnosis are essential for timely intervention. The objective of this study was to determine the aetiological profiles and the management of paediatric patients with stridor referred to the Otorhinolaryngology Department of Hospital Serdang. METHODS: Medical records of all paediatric patients presenting with symptom of stridor from January 2010 to February 2015 were reviewed retrospectively. The patients' demographic data, clinical notes, laryngoscope findings, diagnosis and management were retrieved and analysed. RESULTS: Out of the total 137 patients referred for noisy breathing, 121 patients had stridor and were included in this study. There were 73 males and 48 females-most were of Malay ethnicity (77.7%). The age of presentation ranged from newborn to 10 years, with a mean of 4.9 months. Eighteen patients (14.9%) had associated congenital pathologies. The majority were congenital causes (90.9%), in which laryngomalacia was the commonest (78.5%), followed by subglottic stenosis (5.0%), vallecular cyst (2.5%) and congenital vocal fold paralysis (2.5%). Twelve patients (9.9%) had synchronous airway lesion. The majority of the patients were managed conservatively. Thirty-one patients (25.6%) required surgical intervention, of which only one needed tracheostomy. CONCLUSION: Laryngomalacia was the commonest cause of stridor among paediatric patients. A synchronous airway lesion should be considered if the child has persistent or severe symptoms. The majority of the patients were managed conservatively.