Position paper on olfactory dysfunction: 2023

BACKGROUND: Since publication of the original Position Paper on Olfactory Dysfunction in 2017 (PPOD-17), the personal and societal burden of olfactory disorders has come sharply into focus through the lens of the COVID-19 pandemic. Clinicians, scientists and the public are now more aware of the importance of olfaction, and the impact of its dysfunction on quality of life, nutrition, social relationships and mental health. Accordingly, new basic, translational and clinical research has resulted in significant progress since the PPOD-17. In this updated document, we present and discuss currently available evidence for the diagnosis and management of olfactory dysfunction. Major updates to the current version include, amongst others: new recommendations on olfactory related terminology; new imaging recommendations; new sections on qualitative OD and COVID-19 OD; updated management section. Recommendations were agreed by all co-authors using a modified Delphi process. CONCLUSIONS: We have provided an overview of current evidence and expert-agreed recommendations for the definition, investigation, and management of OD. As for our original Position Paper, we hope that this updated document will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency, and generalisability of work in this field.

Clinical Frailty Scale: Translation and Cultural Adaptation into the Brazilian Portuguese Language.

BACKGROUND: Frailty is a biological syndrome that causes adverse events in the health of older adults. However, the Clinical Frailty Scale has not yet been culturally adapted and validated into Brazilian Portuguese language. OBJECTIVES: Our aim was to translate, reproduce and validate the Clinical Frailty Scale (CFS) for the Brazilian Portuguese language. DESIGN: An observational cross-sectional study with senior patients was conducted between Jan 2018 and Nov 2018. SETTING AND PARTICIPANTS: Volunteers aged >60 and living in Brazil. The translation and cultural adaptation of the CFS into the Portuguese language, the principles and good practices were followed. MEASUREMENTS: To conduct the validation and determine the reproducibility of an inter-observer evaluation, the patients answered the scale questions in Portuguese on two occasions, delivered by two separate examiners and separated by a 10-minute interval, on their first visit; the 36-item Short Form Survey quality-of-life questionnaire (SF-36) was also applied. Seven days later, a second visit was undertaken to perform an intra-observer reproducibility assessment. RESULTS: A total of 66 older individuals were enrolled (72 ± 8 years), the majority of which did not present frailty (63.6%) and reported a low physical limitation level in the SF-36. The CFS showed a significant correlation with the SF-36 quality-of-life questionnaire (r= -0.663; p<0.0001) and no statistical difference was observed between intra-rater (p=0.641) and inter-rater (p=0.350) applications, demonstrating the reproducibility and applicability of the instrument. The standard error estimate (SEE) was evaluated and there were no differences between the CFS and the SF-36 (SEE= 1.13 points). CONCLUSION: The Brazilian Portuguese language version of the CFS is a valid, reproducible and reliable instrument for evaluating the impact of frailty on the lives of senior patients.

Position paper on olfactory dysfunction.

Background: Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: • Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. • Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. • Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. • Comprehensive chemosensory assessment should include gustatory screening. • Smell training can be helpful in patients with olfactory loss of several aetiologies. Conclusions: We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.

Position paper on olfactory dysfunction.

BACKGROUND: Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: - Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. - Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. - Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. - Comprehensive chemosensory assessment should include gustatory screening. - Smell training can be helpful in patients with olfactory loss of several aetiologies. CONCLUSIONS: We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.

Investigating phenotypic variability in Colletotrichum lindemuthianum populations.

Colletotrichum lindemuthianum, causal agent of anthracnose in the common bean, has wide genetic variability. Differential bean cultivars and morphological and physiological characteristics were used to analyze 74 isolates of C. lindemuthianum collected in two counties in the state of Minas Gerais, Brazil. Six different races were found, with a predominance of race 65 at both locations. Isolates were classified according to their sensitivities to the fungicide thiophanate-methyl, normally used in the control of common bean anthracnose. In all, ≈10% of isolates were resistant to the fungicide in vitro. Characteristics such as indexes of mycelia growth rate, colony diameter, sporulation capacity, and percentage of germination demonstrated the high genetic variability of C. lindemuthianum. We also observed variation in conidial cytology. The conidia of most isolates showed septa formation after germination, in contrast to septa absence, previously reported in the literature. Sexual and asexual reproduction were evaluated for mechanisms that may contribute in the generation of variability in C. lindemuthianum. Conidial anastomosis tubes were commonly found, indicating that asexual reproduction can help increase variability in this species. Information from this study confirmed high variability in C. lindemuthianum and will guide future studies in basic knowledge and applied technologies.

Simulation of the neutron flux in the irradiation facility at RA-3 reactor.

A facility for the irradiation of a section of patients' explanted liver and lung was constructed at RA-3 reactor, Comisión Nacional de Energía Atómica, Argentina. The facility, located in the thermal column, is characterized by the possibility to insert and extract samples without the need to shutdown the reactor. In order to reach the best levels of security and efficacy of the treatment, it is necessary to perform an accurate dosimetry. The possibility to simulate neutron flux and absorbed dose in the explanted organs, together with the experimental dosimetry, allows setting more precise and effective treatment plans. To this end, a computational model of the entire reactor was set-up, and the simulations were validated with the experimental measurements performed in the facility.

A randomized, double-blind, placebo-controlled trial of anti-IgE for chronic rhinosinusitis.

Evidence suggests IgE may play a role in chronic rhinosinusitis (CRS). We sought to determine if treatment with a monoclonal antibody against IgE (omalizumab) is effective in reducing CRS inflammation. We performed a randomized, double blind, placebo controlled clinical trial in subjects with CRS despite treatment (including surgery). Subjects were randomized to receive omalizumab or placebo for 6 months. The primary outcome was quantitative measurement of sinus inflammation on imaging. Secondary outcome measures included quality of life, symptoms, and cellular inflammation, nasal airflow (NPIF) and olfactory testing (UPSIT). Subjects on omalizumab showed reduced inflammation on imaging after treatment, whereas those on placebo showed no change. The net difference, however, was not different between treatments. Treatment with omalizumab was associated with improvement in the Sino-Nasal Outcome Test (SNOT-20) at 3, 5, and 6 months compared to baseline with no significant changes in the control group. Remaining measures showed no significant differences across treatments. We conclude that IgE plays, at most, a small role in the mucosal inflammation of CRS and the symptoms. Placebo controlled, blinded studies with larger enrollment are needed to determine the clinical significance of any potential change.

Sexual recombination in Colletotrichum lindemuthianum occurs on a fine scale.

Glomerella cingulata f. sp phaseoli is the sexual phase of the fungus Colletotrichum lindemuthianum, the causal agent of common bean anthracnose. This fungus is of great concern, because it causes large economic losses in common bean crops. RAPD markers of five populations of G. cingulata f. sp phaseoli from two Brazilian states were analyzed to determine if this population possesses the sexual reproductive potential to generate the genetic variation that is observed in this phytopathogen. We identified 128 polymorphic bands, amplified by 28 random primers. The estimates of genetic similarity in this analysis ranged from 0.43 to 1.00, and the dendrogram generated from analysis of all genotypes displayed five principal groups, coinciding with the five populations. Genetic differentiation was observed between the populations (GST=0.6455); 69% of the overall observed genetic variation was between individual populations and 31% of the variance was within the sub-populations. We identified significant levels of linkage disequilibrium in all populations. However, the values of the disequilibrium ranged from low to moderate, indicating that this pathogen maintains a genetic structure consistent with sexual reproduction. The mean contribution of sexual reproduction was determined by comparison of the amplitudes of genetic similarity of isolates from sexual and asexual phases. These results support the hypothesis that recombination plays an important role in determining the amplitude of variability in this pathogen population and that this determination occurs on a fine scale.

La calidad de vida de pacientes asmáticos evaluada por el WHOQOL-BREF y el SGRQ / The quality of life of asthmatic patients evaluated by the WHOQOL-BREF and the SGRQ

ObjetivosLos objetivos del estudio fueron analizar la calidad de vida de pacientes asmáticos, evaluada mediante un instrumento genérico y otro específico, así como comprobar la correlación entre ambos.Material y métodoEstudio trasversal, descriptivo y observacional en el que participaron 51 asmáticos adultos (26 varones y 25 mujeres) con edad media de 54,46 años (SD 19,17 años), todos reclutados a partir de las consultas externas del Hospital Universitario de Salamanca, entre octubre de 2008 y marzo de 2009. Se realizó una evaluación clínica inicial que incluía una espirometría, formulario sociodemográfico y la aplicación de las versiones españolas del World Health Quality of Life-Bref (WHOQOL-BREF) y del Saint George Respiratory Questionnaire (SGRQ).ResultadosLa edad correlacionó de forma inversa y significativa con todos los dominios del WHOQOL-BREF y solo con el dominio actividad del SGRQ. La clasificación de la gravedad y el volumen espiratorio forzado (FEV1%pred) no presentaron relación con ninguno de los dominios de ambos instrumentos. Los dominios físico y psíquico del WHOQOL-BREF correlacionaron de forma inversa y significativa con todos los dominios del SGRQ.ConclusionesPese a la falta de relación entre la gravedad del asma y los distintos dominios del WHOQOL-BREF, el instrumento ha resultado ser sensible a la variable edad, y 2 de sus 4 dominios han correlacionado con todos los dominios del SGRQ(AU)

ObjectivesThis study has aimed to analyze the quality of life of asthmatic patients, evaluated by one generic and another specific instrument as well as to verify the correlations between them.Material and methodsA cross-sectional, descriptive and observational study with 51 adult asthmatic subjects (26 men and 25 women) with a mean age of 54.46 years (SD 19.17 years), all recruited from the out-patient clinic of the University Hospital of Salamanca, Spain, from October 2008 to March 2009. A clinical evaluation was performed, this including the spirometry, a socio-demographical form and the application of the Spanish version of the World Health Organization Quality of Life (WHOQOL-BREF) and the Saint George Respiratory Questionnaire (SGRQ).ResultsAge correlated inversely and significantly with all the WHOQOL-BREF domains and only with the activity domain of the SGRQ. The severity classification and forced expiratory volume (FEV1%pred) did not show any relationship with any of the domains of both instruments. The physical and psychic domains of the WHOQOL-BREF correlated inversely and significantly with all the SGRQ domains.ConclusionsIn spite of the lack of relation between asthma severity and the different domains of the WHOQOL-BREF, the instrument is sensitive to the age variable and two of its four domains have correlated with all of the SGRQ domains(AU)

Imaging case study: enlarged superior vestibular nerve canal with sensorineural hearing loss.

OBJECTIVE: We report a new temporal bone anomaly - an enlarged superior vestibular nerve canal - associated with sensorineural hearing loss. CASE REPORT: A 10-month-old male infant presented with sensorineural hearing loss together with bilaterally enlarged superior vestibular nerve canals. Compared with published temporal bone computed tomography measurements, our patient's canals were normal in length but approximately double the normal width. In addition, careful review of the imaging did not clearly identify a bony wedge between the superior and inferior vestibular nerve canals. CONCLUSION: Enlarged superior vestibular nerve canal malformation may be a marker for sensorineural hearing loss. Increased vigilance amongst otologists may establish the prevalence of this anomaly and its possible effects on hearing.

Immunoquantitative measurement of soybean aeroallergen emissions at industrial sites.

BACKGROUND: Asthma attacks and mortality due to inhalation of soybean antigens in Barcelona, Spain have been well documented. A new control scheme was adopted in the city to avoid the emission and dispersion of soybean dust into the atmosphere during unloading. We studied soybean allergen emission during unloading and at 3 industrial sites and compared the results obtained. METHODS: Over a period of 31 months, 628 paired air samples from 3 plants (A, B, C) involved in soybean manipulation in Barcelona harbor were collected. Samples were analyzed by a radiometric competitive inhibition assay (RCIA) and the enzyme-linked immunosorbent assay (ELISA). A Bland-Altman plot was used to compare the soybean concentrations measured by each assay. RESULTS: The median values for the 628 samples were 5535 U/m3 (range, 370-18,416,751) for the RCIA and 9955 U/m3 (range, 400-22,349,059) for the ELISA. Plant A had the lowest emission levels and the lowest Spearman rank correlation coefficient (0.409). The correlation coefficients were 0.747 and 0.794 for plants B and C. Soybean aeroallergen concentrations differed by plant. The highest variability in values was seen for plant A, which had the lowest allergen concentrations. CONCLUSIONS: The competitive assays described are useful tools for the measurement of soybean allergen emission levels at industrial sites. These methods may be used to monitor unloading and the impact of environmental interventions.

[Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care]. / Continuidad asistencial. Evaluación de un programa de colaboración entre Atención Hospitalaria y Atención Primaria.

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.

[Recurrent intrathyroid abscess in children. Clinical case and review of the literature]. / Absceso recurrente intratiroideo en niños. Caso clinico y revisión de la literatura.

Recurrent thyroid abscesses in children are an uncommon clinical disorder that use to be due to 3rd or 4th branchial anomalies and pyriform sinus fistula. We are reporting the clinical case ofa 6 year-girl who was diagnosed as left thyroid lobe and istmic abscess of 3 cm, drained by general anesthesia with positive culture for St. Viridans. Four months later she was re-admitted by the same cause and we performed a new drainage, by punction, and endovenous antimicrobial therapy for aerobic and anaerobic pathogens with good evolution. The imaging tests showed no anatomical alterations.

[Paediatric tracheostomy]. / Traqueotomía pediátrica.

INTRODUCTION: Actually we are attending changes in the concept of pediatric tracheostomy. The most important of them is a change in its indications. The aim of our study is to provide our experience about pediatric tracheostomy. METHODS: We are reporting a retrospective study of 16 patients who underwent tracheotomy between 1994-May 2004, reviewing the indications, their complications and evolution. RESULTS: In our study we have only managed to close the tracheostomy in 5 patients and one is waiting surgery, in the rest the pathology has nos allowed us to close it. DISCUSSION/CONCLUSION: Actually the main indication for pediatric tracheostomy is prolonged intubation. Preterm children, the earlier age is done and the longer the intubation is increase the risk of complications but mainly it is the base illness of the patient which will determine the posterior evolution of the tracheostomy.

[Giant cells undifferentiated parotid carcinoma. Report of two cases]. / Carcinoma parotídeo indiferenciado de células grandes. Presentación de dos casos.

Tumours of the salivary glands represent a 5% of all head and neck neoplasms. Their origin is the parotid gland in about 80% of the cases. Most of them are benign. We are reporting two cases of patients diagnosed, by our ENT Department, as undifferentiated giant cells parotid carcinoma with cervical metastasis. They were operated by total parotidectomy and radical neck disection and later recieved treatment with radiotherapy. After two years-follow-up both patients are standing alive. The tumoral size is the most important pronostic factor in this histological type.

[Simultaneous bilateral sudden deafness. Report of a clinical case]. / Sordera súbita bilateral simultánea. Presentación de un caso.

Bilateral sudden deafness is uncommon and characterized by an acute sensorineural hearing loss in both ears of 30 dB or more in 3 consecutive frequencies. We report the case of a 57 yeras old female with this diagnosis who presented a right anacusia and a severe audiometric loss on left ear without vestibular pathology associated. She was admitted and treated by the protocol of medical therapy that we have performed in our E.N.T. Department (4 days EV and then 10 ones oral medication) with improvement in her audition 25-30 dB average. If sudden bilateral sensorineural deafnes is founded, we must consider an immuno-mediated inner ear disease (IMIED).

Effect of cholesterol and ethanol on dermal delivery from DPPC liposomes.

The main objective of the present work was to compare the dermal delivery of minoxidil (Mx), a lipophilic drug from ethosomes versus classic liposomes, containing different cholesterol (CHOL) concentrations. All the systems were characterized for shape, lamellarity, particle size and entrapment efficiency percentage (EE), by transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM), laser diffraction and ultracentrifugation or dialysis methods, respectively. Multilamellar vesicles (MLVs) were obtained and one to six lamellae were visualized by CLSM. The presence of ethanol in the formulations affects the particle size in terms of reducing this parameter. In addition, it was possible to appreciate the influence of CHOL on the vesicle size, because it was increased, as CHOL concentration was higher. When the EE was determined by two different methods (ultracentrifugation and dialysis methods), a clear losing of entrapped drug by the ultracentrifugation method was observed, because the strong energy transmitted to the samples disrupted vesicles. Vesicles were non-occlusively applied on rat skin and the permeation pattern of the different systems, depth into the skin and the main permeation pathway were studied by using beta-carotene as a fluorescent probe. CLSM studies showed that ethosomal systems were much more efficient at delivering the fluorescent substance into the skin in terms of quantity and depth, than either liposomes or hydroalcoholic solutions.

[Glossopharyngeal neuralgia. A propos of one clinical case]. / Neuralgia del glosofaríngeo. A propósito de un caso clínico.

Glossopharyngeal or the 9th cranial nerve neuralgia is an uncommon pathology characterized by severe paroxysmal attacks of pain in the base of the tongue, posterior pharynx and tonsillar fossa some times associated with pain irradiated to the ear. It's Carbamazepine is the first choice of medical treatment while the microvascular decompression is considered the main surgical procedure.

Efficient MILP formulations for the optimal synthesis of chromatographic protein purification processes.

The use of recombinant proteins has increased greatly in recent years, as well as the techniques used for their purification. The selection of an efficient process to purify proteins is a major bottleneck found when trying to scale up results obtained in the laboratory to a large-scale industrial process. One of the main challenges in the synthesis of downstream purification stages in biotechnological processes is the appropriate selection and sequencing of chromatographic steps. The objective of this work is to develop mixed integer linear programming models for the synthesis of protein purification processes. Models for each chromatographic technique rely on physicochemical data of a protein mixture, which contains the desired product and provide information on its potential purification. Formulations that are based on convex hull representations are proposed to calculate the minimum number of steps from a set of chromatographic techniques that must achieve a specified purity level and alternatively to maximize purity for a given number of steps. The proposed models are tested in several examples with experimental data and present time reductions of up to three orders of magnitude when compared to big-M formulations.

[Treatment of thyroid cancer. Retrospective study and review of the literature]. / Tratamiento del cáncer de tiroides. Estudio retrospectivo y revisión de la literatura.

We present a retrospective study about our experience in the treatment of thyroid carcinoma. For that, between 1992 and 1997, we have collected 37 malignant thyroid tumours (15%) over 250 operations on thyroid gland by our ENT Service. We analysed several variables: Age, sex, personal antecedents, clinical symptoms, results of the complementary tests (thyroid hormones, ultrasonography, scintigraphy and FNAB), type of surgery complications and number of recurrences. The thyroid carcinomas, specially differentiated tumors, are an increasing pathology with tendency to affect females. In our serie usually they are solitary thyroid nodes, scintigraphically cold ones, in which FNAB as the best test. We think that a total thyroidectomy is the best treatment and it must be made by an ENT.