Self-reported alteration of sense of smell or taste in patients with COVID-19: a systematic review and meta-analysis on 3563 patients.

BACKGROUND: Emerging reports suggest that new onset of smell or taste loss are potential early clinical markers of SARS-CoV-2 infection, but it remains unclear as to what extent. Therefore, the purpose of this study is to systematically assess the prevalence of self-reported altered sense of smell or taste in patients with confirmed SARS-CoV-2 infection, overcoming the limitations of individual studies by meta-analysis of pooled data. METHODS: The databases Medline, Embase, Web of Science, Scopus and MedRxiv's set were searched from inception to the 4th May 2020. This study was conducted following the PRISMA checklist. RESULTS: 18 studies met the eligibility criteria out of the 171 initially screened citations. The overall prevalence of alteration of the sense of smell or taste was 47% , but estimates were 31% and 67% in severe and mild-to-moderate symptomatic patients, respec- tively. The loss of smell and taste preceded other symptoms in 20% of cases and it was concomitant in 28%. CONCLUSIONS: Based on this meta-analysis, we recommend self-isolation and testing, where possible, for patients complaining smell or taste impairment during COVID-19 pandemic in order to prevent spread of disease and propose the inclusion of loss of smell and taste as recognized symptoms of SARS-CoV-2 in the World Health Organization and other relevant regulatory body's lists.

Gold vs D-penicillamine double blind study and followup.

We undertook a controlled random double-blind comparing gold and penicillamine. Of the 50 patients with rheumatoid arthritis entered into the study, 34 completed the protocol. We found no significant differences in the clinical results, laboratory variables, or toxicity. Longterm followup of 55 months revealed that a significant number of patients were no longer on either drug. The notable exceptions were those who were felt to be in remission from either drug, and remained on gold, or penicillamine. No toxicity from penicillamine involving known immunological aberration has thus far been encountered.

Intramuscular gold for rheumatoid arthritis.

Improvement from gold therapy is not immediate but comes about very slowly. The patient and physician should be forewarned that as many as 8 to 14 weeks may pass before any benefit is noted, and that months of treatment may be required before improvement is sufficient to decrease disability. With effective therapy, signs of inflammation gradually decrease, pain abates, and function improves. Not all patients benefit, and whether beneficial results occur can be determined only by clinical trial. There is no advance method of determining whether treatment will be effective. Gold therapy suppresses rheumatoid inflammation and checks the progress of the disease. It should not be used alone, but shoud be part of a well-planned program of treatment carefully adjusted to the needs of the individual. This therapy will include steroidal and nonsteroidal anti-inflammatory agents (including aspirin), which should not be reduced or abandoned until definite improvement from gold can be determined. With the possible exception of palindromic and juvenile forms, RA is the only rheumatic disease benefited by intramuscular gold therapy. The treatment should never be used for other forms of rheumatism.

Chrysotherapy. A prospective study.

A 4-year prospective clinical study of chrysotherapy was designed to reexamine old beliefs and traditions, and to test potentially new approaches to chrysotherapy. The standard weekly dosage of 50 mg was compared to that based on 1 mg/kg body weight; no significant differences were found. The rapidly absorbed aqueous thiomalate was compared to the slowly absorbed oil repository thioglucose; the latter produced significantly less side effects and an appreciably higher percentage of improvement. Almost half (43%) of nonresponders on standard regimen had a satisfactory clinical response at higher dosage levels without increase in toxicity. Some of these findings vary so much with traditional beliefs and practices that the authors urge caution in their interpretation. But generally speaking these problems are technical and do not detract from the conviction that chrysotherapy is valuable and comparatively safe in the management of rheumatoid arthritis and that it deserves more widespread application in clinical practice.