To ensure the safety and quality of vaccines, especially the newest RNA-vaccines against COVID-19, is one of the World Health Organization’s current highest priorities.Case description.We report th...

An altered sense of smell and taste was recognized as one of the most characteristic symptoms of coronavirus infection disease (COVID-19). Despite most patients experiencing a complete functional resolution, there is a 21.3% prevalence of persistent alteration at 12 months after infection. To date, magnetic resonance imaging (MRI) findings in these patients have been variable and not clearly defined. We aimed to clarify radiological alterations of olfactory pathways in patients with long COVID-19 characterized by olfactory dysfunction. A comprehensive review of the English literature was performed by analyzing relevant papers about this topic. A case series was presented: all patients underwent complete otorhinolaryngology evaluation including the Sniffin’ Sticks battery test. A previous diagnosis of SARS-CoV-2 infection was confirmed by positive swabs. The MRIs were acquired using a 3.0T MR scanner with a standardized protocol for olfactory tract analysis. Images were first analysed by a dedicated neuroradiologist and subsequently reviewed and compared with the previous available MRIs. The review of the literature retrieved 25 studies; most cases of olfactory dysfunction more than 3 months after SARS-CoV-2 infection showed olfactory bulb (OB) reduction. Patients in the personal case series had asymmetry and a reduction in the volume of the OB. This evidence was strengthened by the comparison with a previous MRI, where the OBs were normal. The results preliminarily confirmed OB reduction in cases of long COVID-19 with an altered sense of smell. Further studies are needed to clarify the epidemiology, pathophysiology and prognosis.

Background: Identifying specific endotypes within the broad picture of chronic rhinosinusitis with nasal polyps (CRSwNP), by using biomarkers for instance, remains a challenge. The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) and the eosinophil-to-lymphocyte ratio (ELR) as potential markers of inflammation has already been discussed. Objective: The aim of the present study was to compare NLR and ELR before and after endoscopic sinus surgery (ESS) and nasal mometasone furoate for CRSwNP by stratifying patients by their clinical and histologic features. Methods: The study included 115 consecutive patients with CRSwNP treated with ESS and nasal mometasone furoate, with a postoperative follow-up of >12 months. Eosinophilic-type CRSwNP was histopathologically defined after hematoxylin and eosin tissue staining. Results: In the subcohort of patients with an histologic diagnosis of eosinophilic-type CRSwNP, the mean ± standard deviation ELR significantly decreased after surgery (0.22 ± 0.16 versus 0.18 ± 0.12; p = 0.04), whereas, among patients with a histologic diagnosis of noneosinophilic-type CRSwNP, the mean NLR significantly decreased after surgery (1.98 ± 0.98 versus 1.90 ± 0.90; p = 0.04). Conclusion: Different CRSwNP endotypes are characterized by different biohumoral patterns. It is reasonable to assume that surgery enables clearance of the polyps and polypoid mucosa, which reduces the load of antigens that triggers the inflammation. Consistent with the above-mentioned biologic mechanism, ESS could correspond to a reduction in blood ELR values and eosinophil count in eosinophilic-type CRSwNP. Analysis of the data did not demonstrate an added value of measuring pre- versus postoperative ELR compared with measuring the blood eosinophil count. When used after ESS, topical corticosteroids also had more significant anti-inflammatory effects. As for the subcohort of patients with noneosinophilic CRSwNP, the fact that the mean NLR dropped significantly after surgery was definitely an original finding. Unlike eosinophilic inflammation, the inflammatory patterns seen in noneosinophilic CRSwNP are still poorly understood.