scholarly journals Confirmed central olfactory system lesions on brain MRI in COVID-19 patients with anosmia: a case-series

2020 ◽  
Author(s):  
Yannick Girardeau ◽  
Yoan GALLOIS ◽  
Guillaume DE BONNECAZE ◽  
Bernard ESCUDE ◽  
Clarisse LAFONT ◽  
...  
Keyword(s):  
Orbitofrontal Cortex ◽  
Olfactory System ◽  
Brain Mri ◽  
Case Series ◽  
Olfactory Bulbs ◽  
Olfactory Test ◽  
High Resolution Images ◽  
Smell Disorders ◽  
The Impact

Objective: Anosmia has been listed as a key-symptom associated with the COVID-19 infection. Because it often occurs without any sign of rhinitis, lesions of the central olfactory system have been suspected. To date, however, there is no evidence that anosmia caused by SARS-CoV2 could be the result of brain damage. Methods: We conducted a case-series on 10 consecutive COVID-19 patients who reported anosmia. Each patient prospectively underwent a validated olfactory test (Sniffin Sticks test) and a brain MRI. Results: Hypersignal intensity lesions of the central olfactory system were found in 3 subjects on 3D T2 FLAIR and 2D T2 High Resolution images with a lesion involving the olfactory bulbs and/or the orbitofrontal cortex. These 3 subjects showed a severe and persistent loss of smell on the olfactory test. Mucosal hyperplasia of the upper nasal cavities was found in two other subjects with significant smell disorders. There was no MRI anomaly in two subjects with good smell restoration. Conclusions: Anomalies of the central olfactory system could be responsible for anosmia in patients with COVID-19 infection. Further studies are needed to assess the impact on long-term functional prognosis of these lesions.

EXPRESS: Long-term Neurobehavioral Correlates of Brain Cortical Microinfarcts in a Memory Clinic Cohort in Singapore

2021 ◽  
pp. 174749302110062
Author(s):  
Xin Xu ◽  
Cheuk Ni Kan ◽  
Christopher Li-Hsian Chen ◽  
Saima Hilal
Keyword(s):  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Functional Decline ◽  
Memory Clinic ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Clinical Assessments ◽  
The Impact

Background Cortical cerebral microinfarcts (CMIs) are a small vessel disease (SVD) biomarker underlying cognitive impairment and dementia. However, it is unknown whether CMIs are associated with neuropsychiatric disturbances, and whether its effects are independent of conventional SVD markers. Aims We investigated the associations of CMI burden with incidence and progression of neuropsychiatric subsyndromes (NPS) in a memory clinic cohort of elderly in Singapore. Methods In this prospective cohort, 496 subjects underwent detailed neuropsychological and clinical assessments, 3T brain MRI, and Neuropsychiatric Inventory assessment at baseline and 2 years later. Cortical CMIs and other SVD markers, including white matter hyperintensities, lacunes, and microbleeds, were graded according to established criteria. NPS were clustered into subsyndromes of Hyperactivity, Psychosis, Affective, and Apathy following prior findings. Functional decline was determined using the Clinical Dementia Rating (CDR) scale. Results The presence of multiple CMIs (≥2) was associated with higher NPS-total (β=4.19, 95% CI=2.81-5.58, p<0.001), particularly Hyperactivity (β=2.01, 95% CI=1.30-2.71, p<0.01) and Apathy (β=1.42, 95% CI=0.65-2.18, p<0.01) at baseline. Between baseline and year-2, multiple CMIs were associated with accelerated progression in NPS-total (β=0.29, 95% CI=0.06-0.53, p=0.015), driven by Hyperactivity (β=0.45, 95% CI=0.17-0.72, p<0.01). Subjects with multiple CMIs also had a faster functional decline, as measured with the CDR-sum-of-boxes scores, when accompanied with NPS-total progression (β=0.31, 95% CI=0.11-0.51, p<0.01), or Hyperactivity (β=0.34, 95% CI=0.13-0.56, p<0.01). Conclusion Cortical CMIs are associated with incidence and progression of geriatric neurobehavioral disturbances, independent of conventional SVD markers. The impact of incident CMIs on neurocognitive and neuropsychiatric trajectories warrants further investigations.

scholarly journals Survival Among Patients With Pancreatic Cancer and Long-Standing or Recent-Onset Diabetes Mellitus

2015 ◽  
Vol 33 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Chen Yuan ◽  
Douglas A. Rubinson ◽  
Zhi Rong Qian ◽  
Chen Wu ◽  
Peter Kraft ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Median Survival ◽  
Case Series ◽  
Health Study ◽  
Survival Times ◽  
Recent Onset ◽  
Onset Diabetes ◽  
Diabetes Status ◽  
The Impact

Purpose Long-standing diabetes is a risk factor for pancreatic cancer, and recent-onset diabetes in the several years before diagnosis is a consequence of subclinical pancreatic malignancy. However, the impact of diabetes on survival is largely unknown. Patients and Methods We analyzed survival by diabetes status among 1,006 patients diagnosed from 1986 to 2010 from two prospective cohort studies: the Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). We validated our results among 386 patients diagnosed from 2004 to 2013 from a clinic-based case series at Dana-Farber Cancer Institute (DFCI). We estimated hazard ratios (HRs) for death using Cox proportional hazards models, with adjustment for age, sex, race/ethnicity, smoking, diagnosis year, and cancer stage. Results In NHS and HPFS, HR for death was 1.40 (95% CI, 1.15 to 1.69) for patients with long-term diabetes (> 4 years) compared with those without diabetes (P < .001), with median survival times of 3 months for long-term diabetics and 5 months for nondiabetics. Adjustment for a propensity score to reduce confounding by comorbidities did not change the results. Among DFCI patient cases, HR for death was 1.53 (95% CI, 1.07 to 2.20) for those with long-term diabetes compared with those without diabetes (P = .02), with median survival times of 9 months for long-term diabetics and 13 months for nondiabetics. Compared with nondiabetics, survival times were shorter for long-term diabetics who used oral hypoglycemics or insulin. We observed no statistically significant association of recent-onset diabetes (< 4 years) with survival. Conclusion Long-standing diabetes was associated with statistically significantly decreased survival among patients with pancreatic cancer enrolled onto three longitudinal studies.

scholarly journals The impact of bilateral endoscopic inferior turbinoplasty with or without adenoidectomy on the quality of life of children: a retrospective case series study

2019 ◽  
Vol 48 (1) ◽  
Author(s):  
Ahmed Mourad ◽  
Hussein Jaffal ◽  
Ismaeel El-Hakim ◽  
Hamdy El-Hakim
Keyword(s):  
Quality Of Life ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Case Series Study ◽  
The Impact ◽  
Series Study

Abstract Background Inferior turbinoplasty (IT) and adenoidectomy (Ad) are frequently resorted to in children with chronic rhinitis (CR) refractory to medical therapy. The aim of this study is to document the long-term improvement in quality of life (QOL) in children with CR following endoscopic IT with or without Ad. Methods A retrospective case series study was conducted. We searched a prospectively kept surgical database for children ≤18 years old who had CR who underwent endoscopic IT with or without Ad between 2009 and 2016 at a tertiary care children’s center. Patients with sinonasal pathologies other than CR, had craniofacial syndromes or dysmorphism and had other sinonasal procedures or trauma were excluded. Collected data included demographics, secondary diagnoses, duration of follow-up, and complications of procedures. The Glasgow Children’s Benefit Inventory (GCBI) was administered by phone to assess QOL improvement. Results One hundred sixty-five eligible subjects were identified. Eighty-nine subjects met the inclusion criteria. Data was collected for the 60 subjects that were reached. Forty-two patients had IT only while 18 had IT and Ad. The mean age was 10.7 ± 2.7 years, with 31 males and 29 females. The median duration of follow-up (25th, 75th percentile) was 38.1 months (24.6, 55.8). The median GCBI score (25th, 75th percentile) was 22.9 (6.3, 39.6) revealing an overall positive benefit in all domains. There was only one complication. Conclusions This study validates prior findings regarding improvement of QOL and safety of IT with or without Ad for children with CR and indicates it is maintained in the long term.

Frostbite: an ancient affliction – have we made progress? A case series and review of best practice.

2017 ◽  
Vol 103 (2) ◽  
pp. 114-119
Author(s):  
R J Thomas ◽  
K Heil ◽  
K Johnson ◽  
A M Wood
Keyword(s):  
Military Personnel ◽  
Best Practice ◽  
Early Recognition ◽  
Case Series ◽  
Current Evidence ◽  
Medical Facility ◽  
Preventative Measures ◽  
Field Environment ◽  
The Impact

AbstractFrostbite represents a spectrum of injuries that can have long term, permanent sequelae, resulting in lifelong disability of otherwise young, fit, economically active individuals. Furthermore, it is generally preventable. Military personnel are put at risk of this condition by the nature of their occupation. With preventative measures, early recognition, appropriate evacuation and repatriation to a medical facility, the impact of this condition can be minimised.This article describes a case series of Royal Marines who were medically evacuated due to frostbite during an exercise, and a review of current evidence supporting the management of frostbite in the field environment through to definitive care.

scholarly journals Assessment of Definitions of Sustained Disease Progression in Relapsing-Remitting Multiple Sclerosis

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Brian C. Healy ◽  
David Engler ◽  
Bonnie Glanz ◽  
Alexander Musallam ◽  
Tanuja Chitnis
Keyword(s):  
Disease Progression ◽  
Brain Mri ◽  
Poor Performance ◽  
Functional System ◽  
Short Term ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis ◽  
The Impact

Sustained progression on the expanded disability status scale (EDSS) is a common outcome measure of disease progression in clinical studies of MS. Unfortunately, this outcome may not accurately measure long-term and irreversible disease progression. To assess the performance of definitions of sustained progression, patients with relapsing-remitting MS (RRMS) or a clinically isolated syndrome with evidence of lesions on a brain MRI were included in our study. Fifteen definitions of sustained progression using both the EDSS and the functional system (FS) scales were investigated. The impact of both relapses and changes in provider on the probability of maintaining progression was also evaluated. Although the provider scoring the EDSS sometimes changed during followup, the provider had access to previous EDSS scores. Between 15.8% and 42.2% of patients experienced sustained progression based on the definitions using EDSS as the outcome, but nearly 50% of these patients failed to maintain sustained progression for the duration of followup. When FS scales were used, progression was most common on the pyramidal and sensory scales. Unfortunately, progression on specific FS scales failed to be more sensitive to irreversible disability. Relapses or changes in provider did not explain the poor performance of the measures. Short-term changes in the EDSS or FS scores may not be an accurate marker of irreversible change in RRMS.

scholarly journals LATE-LIFE SUICIDE: IDENTIFYING PREVENTION TARGETS AND MOBILIZING COMMUNITIES TO MANAGE RISK

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S824-S824
Author(s):  
Alexandria R Ebert ◽  
Emily S Bower ◽  
Yeates Conwell
Keyword(s):  
Suicide Risk ◽  
Long Term Care ◽  
Controlled Trial ◽  
Case Series ◽  
Late Life ◽  
World Health ◽  
Term Care ◽  
Nutrition Service ◽  
The Impact

Abstract Adults aged 70 and older have the highest suicide rates in most countries across the globe (World Health Organization, 2014). Prevalence may increase as the Baby Boomers transition into older adulthood (Phillips, 2014). Disease and disability increase risk for late-life suicide, thus identifying opportunities to intervene within the network of services utilized by older adults with illness and disability could reduce suicide risk. This symposium will explore the impact of disease and disability on late-life suicide risk, and present novel ideas for intervention and prevention. Emphasizing the conference theme, we will discuss prevention points spanning networks of care, including mental health and social services, and long-term care. Dr. Bower will frame the scope of the problem by presenting findings of age-stratified associations between physical illness and suicide attempt among older veterans using secondary data from a retrospective case-control study of veterans. Ms. Lutz will present findings on the relationship between disability and suicidal thoughts from a clinical trial of problem-solving therapy. Dr. Lane will discuss management and identification of suicide risk factors during the transition from independent living to long-term care through the lens of a case-series. Dr. Fullen will present preliminary findings from a novel, randomized controlled trial of a community-based suicide prevention training program for nutrition service volunteers. Dr. Yeates Conwell, Co-Director of the Center for the Study and Prevention of Suicide and Director of the Geriatric Psychiatry Program at the University of Rochester Medical Center, will serve as the discussant.

scholarly journals Cardiac Complications Attributed to Hydroxychloroquine: A systematic review of the Literature Pre-COVID-19

2020 ◽  
Vol 16 ◽  
Author(s):  
Georgi Fram ◽  
Dee Dee Wang ◽  
Kelly Malette ◽  
Pedro Villablanca ◽  
Guson Kang ◽  
...  
Keyword(s):  
Case Reports ◽  
Systolic Heart Failure ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Cardiac Complications ◽  
Mesh Terms ◽  
Acute Overdose ◽  
The Impact ◽  
Rheumatological Diseases

Introduction: Hydroxychloroquine has been used for rheumatological diseases for many decades and is considered a safe medication. With the COVID-19 outbreak, there has been an increase in reports associating cardiotoxicity with hydroxychloroquine. It is unclear if cardiotoxic profile of hydroxychloroquine is previously underreported in the literature, or a new manifestation of COVID-19 and therapeutic interventions. This manuscript evaluates the incidence of cardiotoxicity associated with hydroxychloroquine prior to onset of COVID-19. Methods: PubMED, EMBASE, and Cochrane databases were searched for keywords derived from MeSH terms, prior to 4/9/2020. Inclusion eligibility was based on appropriate reporting of cardiac conditions and study design. Results: Sixty-nine articles were identified (58 case reports, 11 case series). Majority (84%) of patients were female, with a median age of 49.2(range 16-92) years. Fifteen of 185 patients with cardiotoxic events were in the setting of acute intentional overdose. In acute overdose, the median ingestion was 17,857  14,873 mg. Two of 15 patients died after acute intoxication. In patients with long-term hydroxychloroquine use (10.5 ± 8.9 years), new onset systolic heart failure occurred in 54 of 155 patients (35%) with median cumulative ingestion of 1,493,800 ± 995,517 mg. The majority of patients improved with withdrawal of hydroxychloroquine and standard therapy. Conclusions: Millions of hydroxychloroquine doses are prescribed annually. Prior to COVID-19 pandemic, cardiac complications attributed to hydroxychloroquine were uncommon. Further studies are needed to understand the impact of COVID-19 on the cardiovascular system to understand presence or absence of potential medication interactions with hydroxychloroquine in this new pathophysiological state.

scholarly journals Early postmortem brain MRI findings in COVID-19 non-survivors

2020 ◽  
Author(s):  
Tim Coolen ◽  
Valentina Lolli ◽  
Niloufar Sadeghi ◽  
Antonin Rovaï ◽  
Nicola Trotta ◽  
...  
Keyword(s):  
Brain Mri ◽  
Case Series ◽  
Brain Lesions ◽  
Postmortem Brain ◽  
Inclusion Criteria ◽  
Olfactory Bulbs ◽  
Posterior Reversible Encephalopathy ◽  
Olfactory Tract ◽  
Reversible Encephalopathy ◽  
Early Postmortem

AbstractImportanceThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuro-invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). Brain magnetic resonance imaging (MRI) data in COVID-19 patients are scarce due to difficulties to obtain such examination in infected unstable patients during the COVID-19 outbreak.ObjectiveTo investigate the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework.DesignProspective, case series study with postmortem brain MRI obtained early (<24h) after death.SettingMonocentric study.ParticipantsFrom 31/03/2020 to 24/04/2020, consecutive decedents who fulfilled the following inclusion criteria were included: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest computerized tomographic (CT) scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility.Main Outcome(s) andMeasure(s)Signs of acute brain injury and MRI signal abnormalities along the olfactory tract and brainstem were searched independently by 3 neuroradiologists, then reviewed with neurologists and clinicians.ResultsAmong the 62 patients who died from COVID-19 during the inclusion period, 19 decedents fulfilled inclusion criteria. Subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent) were observed. Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality.Conclusions and RelevancePostmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19 that might be triggered by the virus-induced endothelial disturbances. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. The absence of brainstem MRI abnormalities does not support a brain-related contribution to respiratory distress in COVID-19.Key PointsQuestionIs there common brain MRI abnormalities patterns in non-survivors of coronavirus disease 2019 ?FindingsIn a case series of 19 non-survivors of severe COVID-19 disease, early postmortem brain MRI demonstrated patterns evocative of intracranial vasculopathy in 4 decedents: subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent). Asymmetric olfactory bulbs were found in 4 other decedents but without downstream olfactory tract abnormalities.MeaningPostmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19 that might be triggered by virus-induced endothelial disturbances.

Ultrastructural analysis of unique glycoconjugates in the rat olfactory system

1992 ◽  
Vol 50 (1) ◽  
pp. 890-891
Author(s):  
James E. Crandall ◽  
Linda C. Hassinger ◽  
Gerald A. Schwarting
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Monoclonal Antibodies ◽  
Olfactory System ◽  
Olfactory Bulbs ◽  
Temporal And Spatial Patterns ◽  
Carbohydrate Epitopes ◽  
Olfactory Systems ◽  
Temporal And Spatial ◽  
Cell Surface Glycoconjugates

Cell surface glycoconjugates are considered to play important roles in cell-cell interactions in the developing central nervous system. We have previously described a group of monoclonal antibodies that recognize defined carbohydrate epitopes and reveal unique temporal and spatial patterns of immunoreactivity in the developing main and accessory olfactory systems in rats. Antibody CC2 reacts with complex α-galactosyl and α-fucosyl glycoproteins and glycolipids. Antibody CC1 reacts with terminal N-acetyl galactosamine residues of globoside-like glycolipids. Antibody 1B2 reacts with β-galactosyl glycolipids and glycoproteins. Our light microscopic data suggest that these antigens may be located on the surfaces of axons of the vomeronasal and olfactory nerves as well as on some of their target neurons in the main and accessory olfactory bulbs.

Suppressed, but Not Forgotten

2011 ◽  
Vol 70 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Beat Meier ◽  
Anja König ◽  
Samuel Parak ◽  
Katharina Henke
Keyword(s):  
Memory Trace ◽  
Thought Suppression ◽  
Test Phase ◽  
Indirect Test ◽  
Final Test ◽  
Test Experiment ◽  
And Control ◽  
Cue Words ◽  
The Impact

This study investigates the impact of thought suppression over a 1-week interval. In two experiments with 80 university students each, we used the think/no-think paradigm in which participants initially learn a list of word pairs (cue-target associations). Then they were presented with some of the cue words again and should either respond with the target word or avoid thinking about it. In the final test phase, their memory for the initially learned cue-target pairs was tested. In Experiment 1, type of memory test was manipulated (i.e., direct vs. indirect). In Experiment 2, type of no-think instructions was manipulated (i.e., suppress vs. substitute). Overall, our results showed poorer memory for no-think and control items compared to think items across all experiments and conditions. Critically, however, more no-think than control items were remembered after the 1-week interval in the direct, but not in the indirect test (Experiment 1) and with thought suppression, but not thought substitution instructions (Experiment 2). We suggest that during thought suppression a brief reactivation of the learned association may lead to reconsolidation of the memory trace and hence to better retrieval of suppressed than control items in the long term.

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