Olfactory and Taste Dysfunction in Patients with Asymptomatic and Mildly Symptomatic COVID-19 in Korea

Background and Objectives@#The association between chemosensory dysfunction (CSD) and coronavirus disease 2019 (COVID-19) remains unclear. The aim of the present study was to determine the incidence of olfactory and taste dysfunction in asymptomatic and mildly symptomatic patients with COVID-19 and to evaluate the symptoms associated with CSD in patients with COVID-19.Materials and Method: On March 9, 2020, 309 patients with asymptomatic or mildly symptomatic COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR) were admitted to the No. 7 Community Treatment Center in Korea. An internet-based survey about symptomatology was administered to these patients, with responses obtained from 244 (79.0%). Subjects who completed the survey were enrolled in this study and were categorized into either a CSD group or a normal chemosensory group based on the presence or absence of CSD, respectively. @*Results@#General symptoms, including fever, myalgia, and chills, were most common (29.1%), followed by upper respiratory tract infection (URI) symptoms (20.9%), CSD (20.5%), and nasal symptoms (13.5%). In patients with CSD (n=50), 10 (4.1%) reported no other symptoms. After adjustment for age, sex, past medical history, and other symptoms, general symptoms [odds ratio (OR), 3.63; confidence interval (CI), 1.70-7.76] and nasal symptoms (OR, 7.00; CI, 2.61-18.80) were significantly associated with CSD. @*Conclusion@#The incidence of CSD was relatively high (20.5%) in asymptomatic and mildly symptomatic patients with COVID-19. General symptoms were independent risk factors of CSD, suggesting a sensorineural mechanism for the observed olfactory and taste dysfunction.

Out-of-Hospital Cohort Treatment of Coronavirus Disease 2019 Patients with Mild Symptoms in Korea: an Experience from a Single Community Treatment Center

The outbreak of Coronavirus Disease 2019 (COVID-19) caused a worldwide pandemic. Less than 6 weeks after the first confirmed cases in Korea, the patient number exceeded 5,000, which overcrowded limited hospital resources and forced confirmed patients to stay at home. To allocate medical resources efficiently, Korea implemented a novel institution for the purpose of treating patients with cohort isolation out of hospital, namely the Community Treatment Center (CTC). Herein, we report results of the initial management of patients at one of the largest CTC in Korea. A total of 309 patients were admitted to our CTC. During the first two weeks, 7 patients were transferred to the hospital because of symptom aggravation and 107 patients were discharged without any complication. Although it is a novel concept and may have some limitations, CTC may be a very cost-effective and resource-saving strategy in managing massive cases of COVID-19 or other emerging infectious diseases.

Out-of-Hospital Cohort Treatment of Coronavirus Disease 2019 Patients with Mild Symptoms in Korea: an Experience from a Single Community Treatment Center

The outbreak of Coronavirus Disease 2019 (COVID-19) caused a worldwide pandemic. Less than 6 weeks after the first confirmed cases in Korea, the patient number exceeded 5,000, which overcrowded limited hospital resources and forced confirmed patients to stay at home. To allocate medical resources efficiently, Korea implemented a novel institution for the purpose of treating patients with cohort isolation out of hospital, namely the Community Treatment Center (CTC). Herein, we report results of the initial management of patients at one of the largest CTC in Korea. A total of 309 patients were admitted to our CTC. During the first two weeks, 7 patients were transferred to the hospital because of symptom aggravation and 107 patients were discharged without any complication. Although it is a novel concept and may have some limitations, CTC may be a very cost-effective and resource-saving strategy in managing massive cases of COVID-19 or other emerging infectious diseases.

Prediction of Outcome after Traumatic Brain Injury Using Clinical and Neuroimaging Variables

BACKGROUND AND PURPOSE: The functional outcome of traumatic brain injury (TBI) varies widely. The aim of this study was to identify the factors predicting outcome following TBI. METHODS: We prospectively enrolled acute TBI patients, and assessed them clinically and radiologically using brain magnetic resonance imaging (MRI). Functional outcome was measured using the Glasgow Outcome Scale (GOS) at 3 months after TBI. A GOS score of < or =4 was regarded as an unfavorable outcome. We performed multivariate analysis to investigate the association between clinicoradiological variables and outcome. RESULTS: Forty-two patients completed the clinical evaluation in the acute phase and outcome measurement at 3 months. Motorcycle accident was associated with unfavorable outcome [odds ratio (OR)=38.3, p=0.022]. If the patients were the victims of the accident, they were more likely to have an unfavorable outcome (OR=21.3, p=0.037). All seven patients with a low Glasgow Coma Scale (GCS) score (i.e., < or =8) at 24 or 48 h after TBI were also found to have an unfavorable outcome. The presence of diffuse axonal injury (DAI) was a significant predicting factor of an unfavorable outcome (OR=8.48, p=0.042). CONCLUSIONS: Motorcycle accident, being an accident victim, and a lower GCS score at 24 hours or more after the accident were found to be unfavorable prognostic variables. DAI was the only radiologic variable predicting an unfavorable outcome. Thus, it is important to identify DAI by applying MRI in the acute phase.

Enhancing Box Sign : Enhancement Pattern of Acute Osteoprotic Compression Fracture

OBJECTIVE: Although gadolinium enhancement of compression fractures is well known, the enhancement pattern of the acute stage of a fracture is not completely understood. Here, we investigated the enhancement pattern of acute vertebral compression fractures (VCFs). METHODS: We conducted a retrospective study of patients with acute osteoporotic VCFs admitted to hospital between January 2004 and December 2005. The demographic details, stage of the fracture, management data, and results were analyzed. There were nine men and 22 women, and the mean age was 71 years (range, 53-92 years). According to the onset of pain, patients were divided into the following four groups : Group I (less than 3 days), Group II (4-7 days), Group III (8-14 days), and Group IV (14-30 days). RESULTS: All patients had central low-signal intensity of the nonenhancing part of vertebral bodies on T1 images. Enhancing box sign (EBS) was seen 7 days of VCF development. After 7 days of onset (Groups III and IV), patch or Kummell's enhancements occurred. EBS has been statistically correlated with stage of compression fracture (Pearson's correlation = -0.774). However, EBS had no statistically significant correlation with prognosis in our study (Pearson's correlation = 0.059). CONCLUSION: EBS represents a characteristic sign 7 days of VCF development.

Pneumorrhachis and Paraspinal Air with Vacuum Disc: Case Report and Literature Review

Air within the spinal canal called pneumorrhachis has been seen rarely. We report a case showing multiple air pockets in the paraspinal and epidural space with vacuum disc and review pathogenesis and treatment of pneumorrhachis.

Vertebral Artery Injury Following Blunt Trauma to the Cervical Spine Case Report and Literature Review

Vertebral artery injury may occur following blunt trauma to the cervical spine and can produce severe neurological deficit. We report upon two patients having vertebral artery injury following blunt trauma to the cervical spine. The first one developed a cerebellar infarct and the second cervical cord ischemia. The possibility of vertebral artery injury should be considered in patients with cervical spine injury, especially in those having a subluxation or fracture of the facet joint. Early signs of vertebral artery injury may be silent. Non-invasive techniques, such as magnetic resonance angiography should be utilized in such cases.

Recurrence and Facial Nerve Function in Relation to the Extent of Resection of Vestibular Schwannoma Surgery

OBJECTIVE: The aims of the surgical treatment of vestibular schwannoma are complete removal with preserving facial nerve function. Complete removal, however, carries significant risk of facial nerve palsy. Alternatively with subtotal removal of tumor, recurrence rate was known to be high. The objective of this study was to assess the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection. METHODS: From 1990 to 1999, 125 cases of vestibular schwannoma were retrospectively reviewed. The degree of resection was classified as gross total resection (GTR), near total resection (NTR), Subtotal resection (STR). The tumor recurrence or re-growth was determined by the increase in its greatest dimension on follow-up imaging studies. Facial nerve function was graded with the modified House-Brackmann Grade postoperatively. For clinical comparison, these were grouped into the categories: good ; grade 1-2, intermediate or poor; 3-6. RESULTS: Of the 125 patients, 28(22%) underwent GTR, 37(30%) had NTR, and 60(48%) had STR. The recurrence rate were 3.5% (1 of 28), 7.8% (3 of 37) and 28% (16 of 60) for GTR, NTR and STR. GTR and NTR showed no statistical difference in recurrence rate (P=0.628). However NTR had less recurrence rate than STR (P=0.034). The postoperative good facial nerve function achieved in 22% of GTR, 53% of NTR and 53% of STR. NTR had lower risk of facial nerve palsy than GTR(P=0.028). CONCLUSION: In treating vestibular schwannoma, NTR had higher facial nerve sparing rate than GTR without significantly increasing the recurrence rate. NTR is a good surgical strategy.