Characterization and Pathogenic Speculation of Xerostomia Associated with COVID-19: A Narrative Review

Patients with coronavirus disease 2019 (COVID-19) have become known to present with different oral symptoms. However, xerostomia remains poorly recognized compared with taste dysfunction. For better understanding of COVID-19 symptomatology, xerostomia associated withCOVID-19 was characterized and its possible pathogenesis was speculated by a narrative literature review. Scientific articles were retrieved by searching PubMed, LitCovid, ProQuest, Google Scholar, medRxiv and bioRxiv from 1 April 2020 with a cutoff date of 30 September 2021. Results of the literature search indicated that xerostomia is one of prevalent and persistent oral symptoms associated with COVID-19. In contrast to taste dysfunction, the prevalence and persistence of xerostomia do not necessarily depend on ethnicity, age, gender and disease severity of patients. COVID-19 xerostomia is pathogenically related to viral cellular entry-relevant protein expression, renin-angiotensin system disturbance, salivary gland inflammation, zinc deficiency, cranial neuropathy, intercurrent taste dysfunction, comorbidities and medications. Despite a close association with COVID-19, xerostomia, dry mouth and hyposalivation tend to be overlooked unlike ageusia, dysgeusia and hypogeusia. Although mouth dryness per se is not life-threating, it has an impact on the oral health-related quality of life. More attention should be paid to xerostomia in COVID-19 patients and survivors.

Effects of Preoperative Oral Carbohydrate on Cirrhotic Patients under Endoscopic Therapy with Anesthesia: A Randomized Controlled Trial

Preoperative fasting causes significant perioperative discomfort in patients. Preoperative oral carbohydrate (POC) is an important element of the enhanced recovery after surgery protocol, but its effect on cirrhotic patients who tend to have abnormal gastric emptying remains unclarified. We investigated the influence of POC on gastric emptying and preprocedural well-being in cirrhotic patients. A prospective, randomized, controlled study of cirrhotic patients with gastroesophageal varices scheduled for elective therapeutic endoscopy under intravenous anesthesia was conducted. We enrolled 180 patients and divided them into three groups: those not supplemented with carbohydrates for 8 h before therapeutic endoscopy (control group) and those administered a carbohydrate beverage 2 h (2 h group) and 4 h (4 h group) before endoscopy. The residual gastric volume was quantified before anesthesia, gastric emptying was evaluated using gastric ultrasonography, and preprocedural well-being was assessed using the visual analogue scale (VAS). Preanesthesia gastric sonography scores were similar among the three groups. No patient had residual gastric volume > 1.5 ml / kg in the control and 4 h groups, but six patients (11%) had a residual gastric volume of >1.5 ml/kg in the 2 h group, hence were at a risk of regurgitation and aspiration. Moreover, VAS scores for six parameters (thirst, hunger, mouth dryness, nausea, vomiting, and fatigue) in the 2 h group and three parameters (thirst, hunger, and mouth dryness) in the 4 h group were significantly lower than those in the control group, suggesting a beneficial effect on cirrhotic patients’ well-being. Preoperative gastric peristaltic and operation scores, postoperative complications, length of hospital stay, and in-hospital expenses were not significantly different among the three groups. Our study indicated that avoiding preoperative fasting with oral carbohydrates administered 4 h before anesthesia can be achieved in cirrhotic patients. Further studies to assess whether POC can help improve postoperative outcomes in cirrhotic patients are needed.

High flow versus conventional nasal cannula for oxygenation and ventilation maintenance during surgery with intravenous deep sedation by propofol: a randomized controlled study

Background The dead space washout and provision of some level of positive airway pressure by nasal high-flow (NHF) cannula could improve the efficiency of ventilation, oxygenation and maintenance of the upper airway in patients undergoing deep sedation. This study aimed to compare the incidences of events represented oxygenation and ventilation, i.e. desaturation and upper airway obstruction, and arterial blood gas (ABG) levels between using NHF cannula and conventional nasal cannula (NC2) during deep sedation of adult surgical patients. Methods In this prospective randomized single-blinded study, the patients who were 20–80 years old, ASA physical status of 1 to 3, scheduled for surgery under intravenous sedation (IVS) were included. The patients were randomly divided into two groups, i.e., NC2 or NHF groups. Propofol infusion was given to maintain deep sedation. The desaturation (SpO2 < 92%) and upper airway obstruction events (presence of snoring with paradoxical breathing) after application of NC2 or NHF were observed and collected. Other outcomes included interventions during IVS, such as jaw lifting or airway instrument insertion, mouth dryness, and post- ABG analyses were also collected and compared. Results Thirty-six patients undergoing endovascular surgery were randomized into NC2 or NHF groups (18 in each group). No patients dropped out of the study. There were no significant differences in age, sex, ASA physical status, pre-sedation and pre-application of NC2 and NHF ABG analyses (PaO2, SaO2, pH, PaCO2, and PaO2/FiO2). NHF group had significantly lower in the incidence of desaturation [5 (27.78%) vs 13 (72.22%), p = 0.008], upper airway obstruction [4 (22.22%) vs 13 (72.22%), p = 0.003], and airway maneuver [6 (33.33%) vs 13 (72.22%), p = 0.019] than NC2 group. There were no differences in the ABG analyses after oxygen supplementation and no significant differences in mouth dryness between groups. Conclusion The use of NHF cannula in patients undergoing endovascular surgery under deep sedation reduced desaturation events and required fewer airway interventions than NC2 with no difference in arterial blood gas analyses and mouth dryness.

An unusual dyspnea in an 87-year old woman affected by Sjögren’s syndrome

Primary Sjögren’s syndrome (pSS) is a progressive autoimmune disease and is characterized by eye and mouth dryness due to lymphocytic infiltration in lacrimal and salivary glands leading to tissue destruction, but it can also present systemic manifestations including lung involvement. Respiratory manifestations in pSS have a prevalence of 9-20% and can be due to airway and/or lung parenchyma involvement, such as in particular in interstitial lung diseases like lymphocytic interstitial pneumonia (LIP). LIP is an inflammatory diffuse parenchymal lung disease, which is almost invariably associated with other conditions, such as autoimmune diseases and immunodeficiency states, and usually affects women with a mean age of 50 years. We described a case of patient with LIP who was referred to our Internal Medicine Unit and the diagnostic issues related to the patient age and comorbidities.

Accuracy of SARS-CoV-2 Detection in Saliva for COVID-19 Diagnosis: A Systematic Review and Meta-Analysis

Context: There is an unmet clinical need to develop simple, easy, rapid, and accessible testing for the detection of SARS-CoV-2. Recent reports suggested that saliva may be a host for the virus. The existence of SARS-CoV-2 in saliva can be associated with oral manifestations in infected patients. A systematic review was conducted as well as a meta-analysis to evaluate the diagnostic accuracy of detecting SARS-CoV-2 in saliva and investigate the association between positive saliva test and oral manifestations of COVID-19. Evidence acquisition: A literature search in MEDLINE via PubMed, Scopus, Web of Science, and Cochrane was done in June 2020 and updated in February 2021 using relevant keywords. We screened studies for eligibility. The extracted data were analyzed using Meta-Disc software. Results: Eighteen studies were included. Pooled data from eligible studies showed that the sensitivity of diagnosis of SARS-CoV-2 in saliva was 0.86 (95% CI, 0.83–0.89), and the specificity was 0.98 (95% CI, 0.96–0.98). COVID-19 was associated with oral diseases as amblygeustia, dry mouth, dryness, inflammation of the mouth, and enlargement of lymph nodes in the submandibular regions. Conclusions: Our results showed that the saliva has a high accuracy in the detection of SARS-CoV-2.

Relationship between Subjective Dry Mouth Feeling and Cognitive Dysfunction Assessment in Elderly in Some Areas

Objectives: The purpose of this study was to determine the relevance of cognitive impairment assessment due to subjective oral dry symptoms in older adults. Methods: After a three-month survey of patients visiting some dental hospitals in Busan from December 2019, the final 111 people were analyzed using the SPSS 26.0 program. Results: Groups with high subjective mouth dryness showed higher levels of cognitive dysfunction than those with lower subjective mouth dryness(<.001), and subjective mouth dryness showed a static correlation with the evaluation of cognitive dysfunction(r=.338, p<.01). Conclusions: Therefore, this study is considered to be a meaningful study that approaches the elderly's health problems in the aged society from various angles, and it is intended to be used as a basic data for the development of elderly health prevention programs as well as the prevention of geriatric diseases.

AB0794 CONTRIBUTION OF LABIAL SALIVARY GLAND BIOPSY: EXPERIENCE OF THE DEPARTMENT OF RHEUMATOLOGY OF THE UNIVERSITY HOSPITAL OF IBN ROCHD (ABOUT 57 CASES)

Background:Labial salivary gland biopsy (LSGB) is a histological examination indicated for the diagnostic workup of systemic diseases such as Sjogren’s syndrome, amyloidosis, or sarcoidosis.Objectives:To study the contribution of LSGB to the diagnosis of Sjogren’s syndrome, amyloidosis, and sarcoidosis.Methods:We conducted a retrospective study of LSGB histopathological reports and clinical data of patient medical records collected in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca, between January 2019 and June 2020. Histology assessed Chisholm and Masson’s sialadenitis score, looked for amyloidosis, and sarcoidotic granulomas.Results:A total of 57 LSGBs were performed, of which 2 were excluded from our study because of lack of clinical data. The sex-ratio M/F was 0.1, and the median age was 53 (22 – 85). The indications were subjective eyes and mouth dryness in 40% of cases, the search for sarcoidosis and amyloidosis in 23.6% of cases, the assessment of a dryness syndrome in the context of chronic inflammatory rheumatism in 18.2% of cases, isolated dryness of the mouth in 14.5% of cases, and the search for amyloidosis in the context of a known primary Sjögren syndrome in 3.6% of cases. The stages of Chisholm and Masson for sialadenitis found were: stage I at 56.6%, stage II at 24.5%, stage III at 11.3%, and stage IV at 7.5%. Among the LSGBs performed for dryness syndrome, stages III and IV were found in 18.2% of cases among subjective eyes and mouth dryness, in 12.5% of cases among isolated mouth dryness, and in 20% of cases among chronic inflammatory rheumatisms. Three cases of AA amyloidosis (5.5%) were diagnosed. No sarcoidosis granulomas were found.Conclusion:LSGB is a simple and frequent investigation. The Chisholm stage most often found in our series was stage I, followed by stages II, III, and IV respectively. This is consistent with the results of the study of Baeteman et al (1). In addition, amyloidosis was only found in our series in 5.5% of cases, also matching with the results of Baeteman et al. (4.2%). Their study showed that LSGB has a great diagnostic interest in these two pathologies, with a sensitivity of 52-75% and a specificity of 90-100% for Sjogren’s syndrome, and a sensitivity of 48-80% and a specificity of 93-100% for amyloidosis (2). LSGB remains a simple investigation test, contributing to the diagnosis of Sjogren’s syndrome, amyloidosis, and sarcoidosis.References:[1]Baeteman C, Guyot L, Bouvenot J, Chossegros C, Cheynet F, Loudot C, et al. Faut-il encore effectuer des biopsies des glandes salivaires accessoires? Revue de Stomatologie et de Chirurgie Maxillo-faciale. 2008 Jun;109(3):143–7.[2]Scardina GA, Spanó G, Carini F, Spicola M, Valenza V, Messina P, et al. Diagnostic evaluation of serial sections of labial salivary gland biopsies in Sjögren’s syndrome. Med Oral Patol Oral Cir Bucal. 1 déc 2007;12(8):E565-568.Disclosure of Interests:None declared

Prevalence of low protein intake in 80+-year-old community-dwelling adults and association with dietary patterns and modifiable risk factors: a cross-sectional study

Low protein intake may accelerate age-related loss of lean mass and physical function. We investigated the prevalence of low protein intake (<1·0 g/kg/day) and the associations between dietary patterns, modifiable risk factors and low protein intake in self-reliant community-dwelling adults ≥ 80 years. This cross-sectional study consisted of two home visits. Data collection consisted of physical measurements (e.g. physical function, physical activity) and self-report of nutritional intake (4-d food records), appetite, eating symptoms and medical conditions. Binary analyses were performed to compare participants with low and normal protein intake. Multiple logistic regression analyses were performed to investigate associations between low protein intake, dietary patterns and modifiable risk factors adjusted for age, sex, BMI categories and diseases. One hundred twenty-six were included in the study. Prevalence of low protein intake was 54 %. A greater day-to-day variation in protein intake was associated with low protein intake (adjusted OR 2·5; 95 % CI 1·14, 5·48). Participants with low protein intake had a higher prevalence of nausea, diarrhoea and mouth dryness. Reduced appetite, mouth dryness and pain increased odds of low protein intake (adjusted OR 3·06, 95 % CI 1·23, 7·63; OR 3·41, 95 % CI 1·51, 7·7; OR 1·54, 95 % CI 1·00, 2·36, respectively). There was a high prevalence of low protein intake in community-dwelling adults aged ≥ 80 years. Day-to-day variability, appetite, mouth dryness and pain may be potentially modifiable risk factors. Targeting dietary patterns and risk factors in primary prevention strategies may potentially improve intake of protein and minimise risk of physical frailty.

Salivary and imaging-based biomarkers of radiation therapy-induced xerostomia

Biomarkers are anatomical characteristics or naturally occurring measurable molecules indicating physiological or pathological state of an individual. These biomarkers have the potential to detect or predict diseases at an early stage which is particularly beneficial in timely management of the common complications of radiation therapy done in head and neck cancer treatment regime. Xerostomia is one of the most common oral complaints of radiation therapy. Saliva has an abundance of protein biomarkers; however, those related to post-radiation therapy xerostomia needs to be explored further. Textural and imaging-based biomarkers are helpful in predicting xerostomia in such patients. This narrative review provides an account of the salivary protein and imaging-based biomarkers of radiation therapy-induced xerostomia in head and neck cancer patients. Keywords: chemotherapy, mouth dryness, head and neck cancer, radiotherapy, salivary glands

Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides —What’s changed in Version 2020?

The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides present evidence on symptom management in user-friendly formats and using plain language. The aim of this work is to summarize changes to the practice guides based on new evidence including management specific to immune checkpoint inhibitors (ICIs). A systematic review of literature was conducted to identify clinical practice guidelines and systematic reviews. For version 2020, there is new evidence from 86 sources (range 2–16; mean 9 per guide), including 14 specific to ICIs, and we removed 21 outdated sources. The 15 COSTaRS practice guides were updated and 2 new guides created for mouth dryness and skin rash. The National Cancer Institute's common terminology criteria for adverse events (NCI-CTCAE) grading was added to the assessment results. “Review self-care strategies” was changed to “Review 3 or more self-care strategies”. There were changes based on new evidence and ensuring consistency across practice guides. The 2020 update was validated by oncology nurses from across Canada.